Client Policy Specialist

Apply NowPosition Overview:

The Client Policy Specialist is a client facing role that is responsible for interpreting and assessing client payment policy data, as well as being able to document the configuration required for the application of payment policy of Zelis edits.

Key responsibilities:

· Present Zelis edit opportunities during new client implementations and upsell new edit opportunities to assigned production clients.

· Review client and payment policy documents. Interpret and document the configurations to be applied to Zelis edits.

· Conduct research and analysis for payment policy items for configuration of Zelis edits; advise how they can be configured to comply with client specific payment policies.

· Translate client payment policy to Zelis edit configurations.

· Understand and articulate payment policies; present the policies and associated edit configuration for review and acceptance by the client.

· Provide direction to internal team based on understanding of client payment policies.

· Proactively lend expertise to implementation team.

· Communicate effectively with various members of the client team (internal as well as external) to share client opportunity and limitations.

· Work with Healthcare Economics team to understand data and report impact and opportunity to client.

· Apply project management principles in initiating, creating and managing projects.

· Review and analyze client inquiries for clarity of intent; apply decisions for affected policies while maintaining information and communicating effectively with the client.

· Monitor, research, and summarize changes as client payment policy changes.

· Ensure compliance with HIPAA regulations and requirements.

· Participate in any staff training as necessary.

· Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

professional experience:

· 5-10+ years of relevant experience or equivalent combination of education & work within healthcare payers

· Extensive knowledge of reimbursement methodologies and acceptable billing practices

· Knowledge of payer reimbursement policies, state and federal regulations and applicable industry standards

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

· Project management

· Experience managing internal and external relationships

· Excellent verbal & written communication skills

· Proficient in Microsoft Office, Word, Excel

direct reports:

None

education:

Bachelor’s Degree Preferred

work environment:

· Travel requirements to (primarily) domestic destinations should not exceed 10%.

· 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.

· A standard business environment exists with moderate noise levels.

· Ability to lift and move approximately thirty (30) pounds on a non-routine basis.

· Ability to sit for extended periods of time.

Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claims. Zelis delivers integrated network analytics, network solutions, payment integrity, electronic payments and claims communications for payers, healthcare providers and consumers in the medical, dental and workers' compensation markets nationwide. Zelis is backed by Parthenon Capital Partners and Bain Capital.

“We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.” Apply Now