Medical Coding - Client Policy Specialist

The Client Policy Specialist is a client facing role that will act as the subject matter expert (SME) as it pertains to Zelis editing product in support of the growth, and expansion of assigned clients. The Client Policy Specialist will lead the sales overview discussion of new/existing opportunities for the Zelis editing product during client meetings in partnership with the Client Management team. This includes, but is not limited to, review of client data to identify pre/post-production edit volume and savings, edit trends, outliers while providing rationale and potential customization options to ensure Zelis edit logic is aligned with internal policies of assigned clients and their specific Lines of Business. The Client Policy Specialistwill ensure day-to-day activities of assigned team aligns with the overall mission and adherence to best practice policies as defined by the organization.
ESSENTIAL FUNCTIONS:

• Demonstrate an expert level understanding of Zelis editing products with an ability to clearly articulate correct coding and claim adjudication guidelines, interpretation of client policies and present Zelis edits/editing suites to assigned clients.
• Primary contact for Client Manager to support the retention and expansion of Zelis Editing Products for assigned clients.
• Ability to work day-to-day with autonomy. Individual contributor as it pertains to assigned clients but works well with CPS team and provides guidance and asks questions as needed.
• Proactively partner with Zelis assigned clients to assist in questions, concerns, and provide explanations regarding editing logic, CMS rules and regulations, and assist in client operational efficiencies.
• Ability to recommend editing adjustments and modifications as needed to product and to the client.
• Includes and identifies individual stakeholders for client meetings, needs, and solutions.
• Schedule internal stakeholder meetings for new edit offerings for assigned clients.
• Builds relationships internally with collaborative partners and follows processes well.
• Proactively partner with Client Policy Integration Director for input regarding Pre-Stakeholder meetings to validate pre-production data and client selection based on edit volume/potential savings opportunity.
• Demonstrate expertise in ability to document root-cause analysis of identified client editing issues for escalation to the appropriate Zelis internal team for resolution and communication to the client.
• Proactively monitor, research, and summarize changes to client payment policy during ongoing scheduled client meetings while partnering with Client Policy Team to ensure awareness of updates and revisions to Zelis Edits.
• Proactively monitor, research and present edit customizations to clients to ensure that all customizations are up-to-date and valid.
• Assists in ongoing process improvement and automation.
• Proactively escalate identified Zelis Editing Product issues utilizing all tools and resources to document and resolve issue.
• Effectively collaborate with the Zelis Editing Product team as it pertains to editing solutions, new edit releases, and product issues.
• Proactively partner with Product and Product Analytics team to obtain impact analysis with claim level details for production edits for all assigned clients to support upsell of existing/new production edit opportunities.
• Partner with Client Integration Specialist and Implementation teams to support the implementation of the Zelis Edit Products for new/existing clients which includes but is not limited to edit presentation, interpreting client policies, provide guidance for requested client customizations and support testing and client "go-live".
• Effectively partner with Edit Configuration and Claims Edit Validation Team to confirm client selected edit package set up with various lines of business (when applicable), interpret intent of client requested customizations, confirm configuration of requested customizations, and support post-production validation of selected client approved edit and newly deployed edits.
• Ensure compliance with HIPAA regulations and requirements.
• Travel requirements to (primarily) domestic destinations should not exceed 10%.

Required Experience:

• 3+ years working for a healthcare payers, third party administrators, or health plans in one of the following areas: claims, editing, coding, billing, etc.
• 3+ years client facing and/or provider facing experience which includes but is not limited to conducting product overview and sales workshops.
• Active coder certification required: coder (AAPC or AHIMA) or Registered Health Information (RHIA/RHIT).
• Experience of correct coding and industry standard claim adjudication guidelines and policies.
• Experience and ability to translate coding and adjudication guidelines, policies and references into edit policies and rules.
• Experience in managing internal/external relationships with strong Project Management skills.

Preferred Experience:

• Bachelor's degree
• Microsoft Office suite (Word, Excel, Power Point etc.)
• JIRA

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We're Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
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 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.
We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.
Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com
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