Quality & Training Specialist


Bedminster, NJ

Industry: Healthcare IT


5 - 7 years

Posted 325 days ago

  by    Vashti Hemraj

This job is no longer available.

Zelis is a healthcare information technology company and market-leading provider of end-to-end healthcare claims cost management and payment solutions.


nc.5000 award winner: One of the fastest growing privately held companies in the US!

Ranked #1 by NJ Biz as the Fastest Growing Company in NJ!



Zelis Healthcare is an information technology company which utilizes an end-to-end technology platform to fulfill the claims cost management and payments needs of healthcare payors including large and medium-sized health plans, TPAs, Taft-Hartley Plans, providers and individuals. The company provides a comprehensive portfolio of network management, claims integrity, payment remittance solutions and analytical services for medical, dental and workers' compensationclaims to over 500 payor clients. Additionally, the company delivers electronic payments and explanation of payments to over 200,000 healthcare providers and serves individuals with provider lookup and medical referral services.


Responsible for training of all new hires in the Claims Editing dept. Auditing of personnel to ensure accuracy and productivity is within company policy, in addition to auditing technology. Continuing education post-audit and assist in quantifying metrics for the department.


  • Mastery in Zelis Claims Editing product offering including but not limited to code edit logic, software, application and workflow processes
  • Creation of efficiencies, streamline processes and enhancements for training and auditing process
  • Accountable for creation, enhancement and maintenance of reporting methodologies to ensure productivity and accuracy is maximized
  • Identifying needs for additional training, i.e. webinar on E/M documentation
  • Responsible for testing CMS enhancements, editing software/proprietary edits addition/updates
  • Utilizing the most up to date documentation/guidelines for both educational and auditing purposes
  • Participate in any staff training as necessary
  • Performs other related responsibilities as assigned
  • Maintain awareness of and ensure adherence to Zelis standards regarding privacy
  • Has proficient knowledge in medical coding and use of various research manuals and guidelines used to render decisions on behalf of Zelis Clients
  • Has thorough understanding of relevant technical aspects of Claims Editing software and solutions and its impact on Clients
  • Computer proficiency and technical aptitude with the ability to utilize CMS, MS Word, Excel, Power Point, Access.
  • Thorough knowledge of company and departmental policies, procedures and workflows


  • 5+ years healthcare and medical claims processing experience within a provider?s office/ ASC or Payer
  • 5+ years?experience with training others
  • CPC and ICD-10 certified or equivalent certification required, maintained in good standing
  • Excellent customer service skills
  • Exceptional professionally written communication skills
  • Diligent research and organizational skills
  • Ability to multi-task and detailed-oriented required
  • Knowledge of Microsoft Word & Excel a must