• Bachelor’s degree or equivalent experience in healthcare administration, business administration, or a related field 

• Five+ years of experience in Medicaid billing, reimbursement, claim payment or cost reporting. 

• Experience with Medicare/Medicare Advantage or commercial billing and reimbursement a plus 

• Ability to manage/oversee pricer program. 

• Subject matter expertise in prospective payment systems and advanced reimbursement methodologies.   

• Strong analytical and critical thinking skills—the ability to correctly decipher dense regulatory or procedural language such as federal or state administrative code.  

• Ability to prioritize multiple tasks and meet deadlines with minimal supervision, including managing program deliverables and providing estimates for deliverables.  

• Ability to define issues, collect data, establish facts, and draw valid conclusions. 

• Strong research and data analysis skills 

• Ability to troubleshoot production issues.  

• Proficient Microsoft Office skills (i.e., functions, macros, pivot tables, data validation, business requirement writing, etc.) 

• Proficient writing SQL queries 

• A good understanding of public and private healthcare payment systems, medical claims, standard claim coding, claim editing, contracting, preferred-provider organizations, narrow networks, and other healthcare-related organizational constructs. 

• Ability to understand in-house developed systems and identify risks with, or gaps in, those systems. 

• Strong communication skills, collaboration, and active listening to contribute to solving problem and building product solutions.  

Location and Workplace Flexibility

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

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. 
 
We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. 

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. 

Disclaimer 

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

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 from time to time.