Remote Client Policy Specialist, CCS, CCS-P, CPC, RHIT, RHIA, RN, or LPN with coding exp (Zelis) 97 views

Job Overview

  • Specialty License LPN, LVN, RN, RHIT, RHIA, CPC, CCS

Zelis is a mid-cap healthcare technology growth company and market-leading provider of integrated healthcare cost management and payments solutions including network analytics, network access, network cost management, payment integrity and electronic payments to payers, healthcare providers and consumers in the medical, dental and workers’ compensation markets nationwide. Zelis is backed by Parthenon Capital Partners. www.zelis.com

OUR ZELIS PURPOSE

We founded Zelis to help control the rising cost of healthcare and make healthcare more affordable for all of us.

POSITION OVERVIEW

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

KEY RESPONSIBILITIES

  • Review client clinical and payment policy documents.Interpret and document the configurations to be applied to Zelis edits.Coordinate review and sign off with the Medical Director prior to implementation.
  • Conduct research and analysis for medical policy items for configuration of Zelis edits; advise how they can be configured to comply with client specific clinical and payment policy.
  • Translate client’s medical policy to Zelis edit configurations.
  • Understand and articulate medical 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 medical 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 and medical 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/QUALIFICATIONS

  • 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

COMPENSATION:

An attractive compensation package comprised of base salary, plus incentives, as well as full benefits has been created to attract outstanding candidates.

OUR BIG 8 ZELIS VALUES

  • We take personal accountability
  • We look for a better way
  • We serve each other and are always there to help
  • We act level-less
  • We use humor
  • We develop serious expertise
  • We act with integrity
  • We celebrate

Thank you for your interest in the Zelis team!

Work Location:

  • Fully Remote

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