About Us

Zelis is modernizing the healthcare financial experience in the United States (U.S.) across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

Why We Do What We Do

In the U.S., consumers, payers, and providers face significant challenges throughout the healthcare financial journey. Zelis helps streamline the process by offering solutions that improve transparency, efficiency, and communication among all parties involved. By addressing the obstacles that patients face in accessing care, navigating the intricacies of insurance claims, and the logistical challenges healthcare providers encounter with processing payments, Zelis aims to create a more seamless and effective healthcare financial system.

Zelis India plays a crucial role in this mission by supporting various initiatives that enhance the healthcare financial experience. The local team contributes to the development and implementation of innovative solutions, ensuring that technology and processes are optimized for efficiency and effectiveness. Beyond operational expertise, Zelis India cultivates a collaborative work culture, leadership development, and global exposure, creating a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we foster a holistic workplace experience. Additionally, the team plays a vital role in maintaining high standards of service delivery and contributes to Zelis’ award-winning culture.

Position Overview

The Edits and Content Analyst role is responsible for development and delivery of initiatives focused on editing and edit content management. The Edits and Content Team manages data driven edits (DDE), new edit content as well as the existing edit content using sources (AMA, CPT, AAPC, CMS, etc.).

The Edits and Content Analyst role will partner closely with the team around projects around the build out of the claims edit platform for physician and facility claims including support for communication and documentation. Will work closely with Ops, Sales & IT departments in the development and maintenance of the maintenance of content as it relates to scalability, functionality, and initiatives imperative to growth.

· Primary focus is on ensuring accuracy of the content data used by the edits during the development and maintenance (clinical content and data).

· Use of strong coding and industry knowledge to research regulatory updates, create and maintain editing content (data used by the edits).

· Research, analysis, and quality assurance of content for edits within the Claims Editing library of edits by testing and validating the data.

· Utilize the most up-to-date approved Zelis medical coding sources for edit maintenance and development while also advising appropriate personnel of important changes, issues, and trends.

· Ensure consistency between edit reference and edit data to ensure adherence to quality assurance guidelines.

· Ensure timely update to the edit as per the maintenance cadence.

· Conduct the root cause analysis of the errors identified and document the issues using the RCA templates.

· Create a preventive action plan and educate the associates to help improve review and accuracy.

· Create and implement training plans for the new associates and ongoing edit education series

· Ensure compliance with HIPAA regulations and requirements

· Perform regulatory research from multiple sources to keep abreast of compliance enhancements and additional editing opportunities.

· Serve as a subject matter expert for content and edits and provide support where needed.

· Work closely with client teams to provide coding expertise for customer and provider inquiries

· Facilitate associates with written responses, documentation and rationale for inquiries as needed.

· Monitor, research, and summarize trends, coding practices, and regulatory changes.

· Performs other related responsibilities and special projects as assigned

· Maintains awareness of and ensure adherence to ZELIS standards regarding privacy.

· Partner with other areas to assess and communicate impact to the business for additions, changes, or updates as it relates to content and edit updates.

professional experience:

· 5+ years’ experience healthcare or related industry.

Good understanding of edit maintenance with proven hands on experience.

· Current certified coder (CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT), or RN, LPN with coding knowledge.

· Proficient in Microsoft Word and PowerPoint.

· Intermediate to Advanced Excel skills preferred.

· Creative problem-solving skills, leveraging insights and input from other parts of an organization while remaining curious.

· Consistently demonstrate ability to act and react swiftly to continuous challenges and changes.

· Excellent analytical skills with data and analytics related solutions.

· Excellent communication skills.

· Strong organization and project / process management skills.

· Strong initiative, self-directed and self-motivation.

· Good negotiation, problem solving, planning and decision-making skills.

· Ability to manage projects simultaneously and achieve goals.

· Excellent follow through, attention to detail, and time management skills.

education:

· Current, active CPC or equivalent credentialing required.

· Bachelor’s Degree mandatory in business, healthcare, or technology preferred.

work environment:

· A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary, due to the needs of the integration team.

· Ability to sit for extended periods of time.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

Commitment to Diversity, Equity, Inclusion, and Belonging

At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity

Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability and require reasonable accommodation with any part of the application and/or interview process, please email talentacquisition@zelis.com.