Medicare Regulatory Pricer 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.

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 Medicare 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 Medicare / Medicare Advantage payment systems. This position requires knowledge of healthcare pricing / reimbursement processes and procedures including institutional, as well as professional payment systems. This position is expected to develop expertise to become 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.

Essential Duties And Functions

• Research and decipher regulatory sources such as legislative rules, federal registers, and bulletins regarding payment rules for Medicare 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.
• Miscellaneous responsibilities as assigned.

Experience, Qualifications, KNOWLEDGE, AND SKILLS

Education

Graduate or equivalent

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 [HIDDEN TEXT].

Skills Required

Sql Queries, Data Analysis, Microsoft Excel