Clinical Client Policy Data Analyst

You will play a crucial role in supporting various initiatives that enhance the healthcare financial experience at Zelis India. Your responsibilities will include reviewing claims within the Clinical Coding Policy queues and maintaining up-to-date clinical guidelines for these claims. You will also analyze specific coding scenarios, assist in edit ideation, and provide root-cause analysis of edit performance issues. Communication and teamwork are essential as you collaborate with the team and leadership to ensure edits are working as intended and to support decision-making with validation data. As the Clinical Coding Policy Analyst, you will work closely with leadership on departmental functions and special projects, as well as with resolution analysts. Your role will involve creating and maintaining job aides to promote consistency in clinical validations and claims workflow process improvements. Additionally, you will assist in submitting IT requests for enhancements and maintaining industry knowledge of claim edit references from organizations such as AMA, CMS, and NCCI. To excel in this role, you must be a Certified Coder (CCS, CCS-P, or CPC) with a preferred background as an RN, LPN, or LVN. You should have a solid understanding of claims workflow, the ability to interpret claim edit rules and references, and apply industry coding guidelines to claim processes. Experience in reviewing Medical Records and applying NCCI editing is necessary, along with proficiency in manipulating data in Excel and managing business relationships. Excellent verbal and written communication skills are vital for effective collaboration and documentation. In addition, you will need a bachelor's degree or equivalent certification such as an active CPC credential. Your role will involve maintaining updated process guidelines, enhancing automation, and documenting improvements to ensure high standards of service delivery. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, Zelis India provides a dynamic environment for professional growth and a holistic workplace experience. Your contributions will be instrumental in upholding Zelis" award-winning culture and optimizing technology and processes for efficiency and effectiveness.,