Sr. Medicaid Regulatory Pricer Analyst

At Zelis, we Get Stuff Done. So, let’s get to it! 

  

A Little About Us 

Zelis is modernizing the healthcare financial experience for all by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts—driving real, measurable results for clients. 

  

A Little About You 

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview

The Sr. Medicaid Regulatory Pricer Analyst will collaborate with the Zelis Regulatory Pricer Product team to further the company’s goals by researching, analyzing, documenting, and communicating rules, regulations, and procedures pertaining to public and private Medicaid payment systems. This position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including institutional, as well as professional payment systems. This position is an internal subject matter expert supporting staff and clients and will need to respond to both internal and external issues in an accurate and timely fashion.

What you'll do:

• Research and decipher regulatory sources such as legislative rules, state registers, waiver programs and bulletins regarding payment rules for State Medicaid programs as well as deciphering contractual language regarding commercial payment arrangements. 

• Draft concise documentation for payment procedures—including payment calculation logic—and collaborate with the development team to refine into user stories with acceptance criteria, including creating test cases/claims with expected pricing outcomes.   

• Perform analysis of various data sources, including but not limited to, published fee schedules and provider files, using in-house or off-the-shelf software (such as Microsoft Excel) 

• Interact with regulators and clients to determine and document business requirements. 

• Lead pricer maintenance, quality assurance activities, audits, troubleshooting, and defect corrections. 

• Educate internal and client staff regarding payment systems and procedures. 

• Updates internal documentation and processes as needed. 

• Work with supporting staff to oversee one or more payment systems. 

• Identify issues upfront and communicate clearly to team members and leadership. 

• Manage competing priorities and deliver quality information and analysis while adhering to deadlines. 

What you'll bring to Zelis:

• 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<