Clinical Client Policy Data Analyst

Role Overview: You will play a crucial role as a Clinical Coding Policy Analyst at Zelis India, where you will be responsible for clinically reviewing claims within the Clinical Coding Policy queues. Your expertise will be utilized to maintain up-to-date clinical guidelines for claim reviews and assist in edit ideation. Working closely with a team, you will analyze specific coding scenarios, provide root-cause analysis of edit performance issues, and contribute to process improvements. Key Responsibilities: - Provide in-depth clinical coding analysis of professional and facility claims based on new or updated edit logic - Conduct in-depth research on coding scenarios and collaborate effectively with the team - Identify and analyze edit performance issues, providing root-cause analysis - Assist in creating and maintaining job aides for consistency in clinical validations and claims workflow - Collaborate with leadership on departmental functions and special projects - Work closely with resolution analysts to ensure effective dispute resolution Qualifications Required: - Certified Coder (CCS, CCS-P or CPC) - RN, LPN or LVN preferred - Ability to interpret claim edit rules and references - Solid understanding of claims workflow and claim forms - Strong knowledge of industry coding guidelines and Clinical Policy interpretation - Experience in audits of claims processes and root-cause analysis - Proficiency in manipulating data in Excel - Experience in managing business relationships - Excellent verbal and written communication skills - 1+ years of experience in reviewing Medical Records and applying NCCI editing Education: - RN or LPN, Bachelors Degree preferred - Current, active CPC or equivalent credentialing required,