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Sr Medicaid Reimbursement Regulatory Analyst - Plano Texas
Company: Zelis Healthcare, LLC Location: Plano, Texas
Posted On: 04/25/2024
Position OverviewAt Zelis, the Sr Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory Pricer Product team to further the company's goals by researching, analyzing, documenting, and communicating rules, regulations, and procedures pertaining to public and private Medicaid payment systems. The Sr Medicaid Reimbursement Regulatory Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including institutional, as well as professional payment systems. This position is an internal subject matter expert supporting staff and clients and will need to respond to both internal and external issues in an accurate and timely fashion.Key Responsibilities - Research and decipher regulatory sources such as legislative rules, federal registers, and bulletins regarding payment rules for Medicare as well as deciphering contractual language regarding commercial payment arrangements
- Draft concise documentation for payment procedures-including payment calculation logic-and collaborate with the development team to refine into user stories with acceptance criteria, including creating test cases/claims with expected pricing outcomes
- Perform analysis of various data sources, including but not limited to, published fee schedules and provider files, using in-house or off-the-shelf software (such as Microsoft Excel)
- Interact with regulators and clients to determine and document business requirements
- Lead pricer maintenance, quality assurance activities, audits, troubleshooting, and defect corrections
- Educate internal and client staff regarding payment systems and procedures
- Updates internal documentation and processes
- Work with supporting staff to oversee one or more payment systems
- Manage competing priorities and deliver quality information and analysis while adhering to deadlinesPreferred Qualifications
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