Quality Analyst supporting the implementation of IT management systems at SONDA. Mapping processes and analyzing performance indicators in a hybrid work environment.
About the role
- Analyze healthcare reimbursement contracts for Zelis, a leading healthcare financial solutions provider. Collaborate with teams to ensure contract accuracy and respond to client issues.
Responsibilities
- Analyze healthcare reimbursement contracts and load contract terms accurately and timely using proprietary software.
- Collaborate with programming and development teams in the creation of calculation methods, database loads or changes.
- Respond to client issues and cases in a timely manner.
- Set up basic contract loads: simple single case agreements (SCAs), basic % of billed charges (BCs), basic % of Medicare, general carve-out codes, and basic fee schedule set up.
- Interpret complex contract terms, analyze reimbursement methodologies, and rate structures (e.g., DRG, APC, CPT/HCPCS, ICD-10).
- Load, maintain, and audit client contracts within the adjudication system.
- Validate and test contract configurations for claims pricing accuracy.
- Maintain fee schedule in contract databases and apply annual escalators for client auto renewals.
- Link contracts to payer products, update and maintain provider groups within client databases for claims routing.
- Handle confidential material regularly and protect confidentiality under established guidelines (HIPAA Compliance).
Requirements
- Bachelor’s Degree or equivalent work experience in Healthcare Revenue Cycle Management/Contracting field
- Microsoft product proficiency.
- Must be an intermediate to expert user of Excel
- Possess strong analytical and math skills
- Self Motivated and Detail Oriented
- Effective written and verbal skills, communicate effectively & expresses ideas clearly and succinctly.
- Develops Self: Seeks opportunities for continuous learning.
- Drives for Results: Delivers high quality work and attains results.
- Plans and Organizes Effectively: Prioritizes the importance of tasks and goals.
- Displays Adaptability: Performs well in high pressure or stressful situations.
Benefits
- Health insurance
- Flexible work arrangements
- Professional development opportunities
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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