Senior Analyst – Device and Non-Monetary Fraud Analytics and Innovation
Bank of America
SQL
Client Inquiry Analyst
Zelis
full-time
Posted on:
Location Type: Hybrid
Location: Atlanta • Florida, Massachusetts, New Jersey, Texas • 🇺🇸 United States
Visit company websiteSalary
💰 $65,000 - $87,000 per year
Job Level
Mid-LevelSenior
Tech Stack
SQLTableau
About the role
- Perform as subject matter expert (SME) to provide coding and claim adjudication guidance for all assigned clients.
- Demonstrate an expert level of understanding of the Zelis editing products with an ability to clearly articulate correct coding and claim adjudication guidelines.
- Demonstrate the ability to provide written responses that provides clarity and guidance to all internal and external client inquiries.
- Effectively utilize all tools and applications for the resolution and escalation of all internal/external edit/claim inquiries.
- Manage day-to-day activities to ensure all inquiries received are responded to and resolved within appropriate timeframes per specified Service Level Agreements (SLAs)
- Actively participate in all external/internal client meetings by providing an overview of identified inquiry or edit trends for assigned clients
- Proactively identify, resolve and escalate client issues while effectively partnering with assigned business partners to maintain strong internal and external relationships
- Effectively analyze data to ensure proactive identification, escalation and resolution of client issues
- Effectively prioritize to deliver on-time completion of all tasks assigned
- Ensure compliance with HIPAA regulations and requirements.
- Build and maintain strong, long-lasting relationships with other teams through regular communication and proactive engagement.
- Analyze client data to identify trends, patterns, and areas for improvement.
- Develop and deliver insightful reports and presentations to clients, highlighting key findings and recommendations.
- Monitor client performance metrics and provide actionable insights to drive client success.
- Collaborate with cross-functional teams to identify and implement process improvements that enhance the client experience.
- Gather and analyze client feedback to inform product development and service enhancements.
- Stay up-to-date with industry trends and best practices to ensure our client success strategies remain competitive and effective.
Requirements
- Bachelor’s degree in Business, Healthcare, Data Analytics, or a related field
- 3+ years of relevant education and work experience with healthcare payers
- Current certified coder (AAPC or AHIMA), Registered Health Information (RHIA/RHIT) certifications, or RN/LPN with coding knowledge required.
- Extensive knowledge of correct coding, industry standard claim adjudication guidelines and policies
- Extensive knowledge and ability to translate coding and adjudication guidelines, policies, and references into edit policies and rules
- Excellent verbal & written communication skills
- Strong analytical skills with the ability to interpret complex data and provide actionable insights
- Proficiency in data analysis tools and software (e.g., Excel, SQL, Tableau)
- Strong problem-solving skills and the ability to think critically and strategically
- Ability to work independently and as part of a team in a fast-paced, dynamic environment
Benefits
- 401k plan with employer match
- flexible paid time off
- holidays
- parental leaves
- life and disability insurance
- health benefits including medical, dental, vision, and prescription drug coverage
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
codingclaim adjudicationdata analysisdata interpretationprocess improvementsreport developmenttrend analysisclient performance metricscoding guidelinesedit policies
Soft skills
communicationanalytical skillsproblem-solvingcritical thinkingteamworkindependencerelationship buildingtime managementproactive engagementclient success strategies
Certifications
certified coder (AAPC or AHIMA)Registered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)Registered Nurse (RN)Licensed Practical Nurse (LPN)
