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Edits and Content Analyst
Zelis (company site, opens in a new tab)5+ yrsHyderabadOn-siteDirect career pageEst. 8–14 LPA
Posted 7h ago
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Job description
Structured overview of role & requirements
About This Role
- Perform end-to-end testing of Zelis edit platforms (PriZem, Visium) to ensure functionality, product integrity, and accuracy in payment integrity processes.
- Analyze clinical and technical requirements to define UAT scope, develop and maintain detailed test scenarios and documentation aligned with claim adjudication guidelines.
- Troubleshoot erroneous results, identify root causes, suggest solutions, and support multiple projects/deadlines while adhering to privacy standards.
Minimum Requirements
- 5+ years of relevant experience in healthcare payer or provider domain or equivalent education/work combination.
- Understanding of medical coding, claim life cycle including adjusted/corrected claims, and claims adjudication process with knowledge of healthcare reimbursement policies and regulations.
- Basic database skills in MS SQL; proficiency in Microsoft Office (Word, Excel).
- Certified coder (CCS, CCS-P, CPC), RHIA/RHIT, or RN/LPN with coding knowledge preferred; Project management experience and SQL Server knowledge are plus but not mandatory.
Ideal Candidate Profile
- Experienced in healthcare claims editing with operational knowledge of claim adjudication and reimbursement methodologies.
- Detail-oriented tester comfortable handling multiple concurrent projects and coordinating across departments without direct supervision.
- Strong analytical and problem-solving skills with the ability to communicate complex concepts effectively, coupled with a structured approach to testing and documentation.