Job description

Overview

The Senior Compliance Analyst will work with the Zelis Payer Compass compliance team to further the company’s goals by researching, analyzing, documenting, and communicating rules, regulations, and procedures pertaining to public and private healthcare payment systems such as Medicare, Medicaid, TRICARE, Workers Compensation, and commercial payment systems. This position requires an in-depth knowledge of healthcare reimbursement processes and procedures including institutional, as well as, professional payment systems. Further, this position is an internal resource to staff and clients and will need to respond to both internal and external issues in an accurate and timely fashion.

Essential Duties and Functions

• Research and decipher complex legal and regulatory sources regarding payment rules for public payment systems such as Medicare, Medicaid (in multiple states), TRICARE, Veteran’s Administration, and Workers Comp (also in multiple states) as well as deciphering contractual language regarding commercial payment arrangements
• Draft concise documentation for payment procedures—including payment calculation logic—and interacting with the development team to refine that documentation into user stories and project plans
• Perform data analysis tasks (i.e., fee schedules, provider files, base rates) using in-house or off-the-shelf software (such as Microsoft Excel)
• Interact with regulators and clients to determine and document requirements
• Assist with implementations, quality assurance activities, compliance audits, troubleshooting, and defect correction
• 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
• Miscellaneous responsibilities as assigned

Experience, Qualifications, Knowledge, and Skills

• Bachelor’s degree or above in healthcare administration, business administration, or a related field
• Minimum of five years of experience in Medicare Part A and/or Part B billing and reimbursement
• Experience with Medicaid billing and reimbursement a plus
• Strong close-reading and analytical skills—the ability to correctly decipher dense regulatory or procedural language
• Ability to define issues, collect data, establish facts, and draw valid conclusions
• Strong research and data analysis skills
• Advanced Microsoft Excel skills (i.e., functions, macros, pivot tables, data validation, etc.)
• Experience with writing queries a plus
• 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
• Ability to prioritize multiple tasks and meet deadlines with minimal supervision
• Superior verbal and written communication skills

Physical Demands

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Sedentary work - Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently to lift, carry, push, pull or otherwise move objects in daily work use (laptop, monitors, et. al). Sedentary work involves sitting most of the time. Use of keyboards (typing) and exposure to computer screens occurs daily. Pleasant work environment in office locations with occasional noise or dust.
• While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands; reach with hands and arms; think; and talk or hear (multi-channel, two-way communication during work hours is required).

Job Type: Full-time

Pay: $75,000.00 - $85,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Parental leave
• Referral program
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Experience:

• healthcare: 3 years (Required)

Work Location: Remote

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