Senior Medicaid Regulatory Pricer Analyst

Zelis

full-time

Posted on: 8/27/2025

Origin: • 🇺🇸 United States • Florida

✨ AI Apply

💰 $71,000 - $95,000 per year

Senior

SQL

About the role

Research and decipher regulatory sources regarding payment rules for State Medicaid programs and commercial payment arrangements
Draft concise documentation for payment procedures and collaborate with development to create user stories and test cases
Perform analysis of data sources including fee schedules and provider files using tools like Excel
Interact with regulators and clients to determine and document business requirements
Lead pricer maintenance, QA activities, audits, troubleshooting, and defect corrections
Educate internal and client staff regarding payment systems and procedures
Update internal documentation and oversee one or more payment systems
Identify issues early and communicate to team and leadership
Manage competing priorities and deliver quality information while adhering to deadlines

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
Ability to manage/oversee pricer program
Subject matter expertise in prospective payment systems and advanced reimbursement methodologies
Strong analytical and critical thinking skills
Ability to prioritize multiple tasks and meet deadlines with minimal supervision
Ability to define issues, collect data, establish facts, and draw valid conclusions
Strong research and data analysis skills
Ability to troubleshoot production issues
Proficient Microsoft Office skills (functions, macros, pivot tables, data validation, business requirement writing, etc.)
Proficient writing SQL queries
Good understanding of public and private healthcare payment systems, medical claims, standard claim coding, claim editing, contracting, preferred-provider organizations, narrow networks
Strong communication skills, collaboration, and active listening