Concept Development Analyst

About Us 

Zelis is modernizing the healthcare financial experience in the United States (U.S.) across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.

Why We Do What We Do 

In the U.S., consumers, payers, and providers face significant challenges throughout the healthcare financial journey. Zelis helps streamline the process by offering solutions that improve transparency, efficiency, and communication among all parties involved. By addressing the obstacles that patients face in accessing care, navigating the intricacies of insurance claims, and the logistical challenges healthcare providers encounter with processing payments, Zelis aims to create a more seamless and effective healthcare financial system.

Zelis India plays a crucial role in this mission by supporting various initiatives that enhance the healthcare financial experience. The local team contributes to the development and implementation of innovative solutions, ensuring that technology and processes are optimized for efficiency and effectiveness. Beyond operational expertise, Zelis India cultivates a collaborative work culture, leadership development, and global exposure, creating a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we foster a holistic workplace experience. Additionally, the team plays a vital role in maintaining high standards of service delivery and contributes to Zelis’ award-winning culture. 

Position Overview

The Concept Analyst role is responsible for development and delivery of initiatives focused on Editing and content management. The Concept Development Team researches and produces new edits and claim review content as well as enhances existing claim review content using sources (ICD-10, AHA, AMA, CPT, AAPC, CMS, clinical research sources, etc.).

The Concept Analyst role will partner closely with the team in producing clinical content for Editing physician and facility claims including support for communication and documentation. Will work closely with Editing and Expert Claim Review Operations and Product teams in the development and maintenance of the content as it relates to scalability, functionality, and initiatives imperative to growth.

Key responsibilities:

 

• Primary focus on concept development for Claims Editing.

• Research and analysis of content for Editing.

• Use of strong coding and industry knowledge to create and maintain Editing.

• Perform regulatory research from multiple sources to keep abreast of compliance enhancements.

• Support for client facing teams as needed relating to client inquiries.

• Analysis of data to assess impact for content related issues or defects. Contribute to product alerts and partner with Product Management on notifications as needed.

• Utilize the most up-to-date approved Zelis medical coding sources for initial edit content build. 

• Partner with other areas to assess and communicate impact to the business for additions, changes, or updates as it relates to content.

• Communicate and partner with Product teams regarding important changes, issues, and trends.

• Ensure adherence to quality assurance guidelines.

• Monitor, research, and summarize trends, coding practices, and regulatory changes.

• Provide recommendation for enhancements or trends relating to content expansion, automation, and efficiencies.

• Actively contribute new ideas and support ad hoc projects, including time-sensitive requests.

• Ensure adherence to quality assurance guidelines.

• Maintain awareness of and ensure adherence to ZELIS standards regarding privacy.

 

 

professional experience:

 

• Preferred Qualifications: Graduate Degree or Equivalent.
• Coding certifications from AAPC/AHIMA is mandatory

·         2 to 4 years’ experience in a related field is required.

• Background and/or understanding of the healthcare industry.

• Knowledge of National Medicare and Medicaid regulations.

• Knowledge of payer reimbursement policies.

• Creative problem-solving skills, leveraging insights and input from other parts of an organization.

• Consistently demonstrate ability to act and react swiftly to continuous challenges and changes.

• Excellent analytical skills with data and analytics related solutions.

• Excellent communication skills.

• Strong organization and project/process management skills.

• Strong initiative, self-directed and self-motivation.

• Good negotiation, problem solving, planning and decision-making skills.

• Ability to manage projects simultaneously and achieve goals.

• Excellent follow through, attention to detail, and time management skills.

Disclaimer

 

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 required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

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 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.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability and require reasonable accommodation with any part of the application and/or interview process, please email talentacquisition@zelis.com.