Client Integration Specialist
Full TimePOSITION OVERVIEW:
The Client Integration Specialist will have primary responsibility for delivering on the key performance components to achieve goals and results for the Zelis Claims Cost Solutions department. The day to day activities of the Client Integration Specialist will align with the overall mission of Zelis Claims Cost Solutions with adherence to best practice policies while serving as a liaison between the Implementation and Edit Configuration team when onboarding new editing clients.
KEY RESPONSIBILITIES:
• Consistently demonstrate outstanding presentation and communication skills while providing an overview of the Zelis edit suites during new editing client implementations
• Effectively partner with Implementation business partners to provide coding guidance and Zelis editing product support during internal and external client meetings
• Provide coding and claim adjudication guidance while interpreting client pre-production data to ensure alignment with assigned client payment policies
• Partner with configuration business partners to ensure appropriate set up and configuration of customization based on client specific payment policies and lines of business
• Facilitate debriefing of client decisions and research policy related issues identified during editing testing process
• Collaborate with business partners to effective support the pre-production testing process for client selected edit suites while providing on-going support to Implementation partners
• Perform as subject matter expert (SME) to provide coding and client specific guidance regarding internal policies and various lines of business
• Partner with Sales Solutions Advisors to obtain pre-sales data to demonstrate an understanding of edit trends, provider behavior and potential client sensitivities to support Zelis editing product presentation
• Utilize reporting tools and metrices to manage deliverables for external and internal client meetings
• Actively participate in day to day client facing activities, new initiatives, processes, and system enhancements
• Ensure compliance with HIPAA regulations and requirements.
• Adhere to Zelis standards regarding privacy.
• The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
PROFESSIONAL EXPERIENCE:
• 8-10+ years of relevant experience or equivalent combination of education & work within healthcare payers
• Extensive knowledge of reimbursement methodologies and acceptable billing practices
• Knowledge of payer reimbursement policies, state and federal regulations and applicable industry standards
• Current certified coder (CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT), or RN, LPN with coding knowledge required
• Must possess outstanding presentation and communication skills with proven ability to deliver client presentations
• Project management
• Experience managing internal and external relationships
• Excellent verbal & written communication skills
• Proficient in Microsoft Office, Word, Excel
DIRECT REPORTS:
None
EDUCATION:
Bachelor’s degree preferred but not required
WORK ENVIRONMENT:
• Travel requirements to (primarily) domestic destinations should not exceed 45%.
• A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.
• A standard business environment exists with moderate noise levels.
• Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
• Ability to sit for extended periods of time.
Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claims. Zelis delivers integrated network analytics, network solutions, payment integrity, electronic payments and claims communications for payers, healthcare providers and consumers in the medical, dental and workers’ compensation markets nationwide. Zelis is backed by Parthenon Capital Partners and Bain Capital.
“We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.”
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