Position Overview
The Senior Content Ideation Specialist role is responsible for development and delivery of initiatives focused on Itemized Bill Review and DRG Validation content management under the Expert Claim Review (ECR) suite of solutions. The Ideation Team researches and produces new content as well as enhances existing Expert Claims Review content using sources such as ICD-10, AHA, AMA, CPT, AAPC, CMS and/or clinical research sources.

This role partners closely with the team in producing clinical content for bill reviews of facility claims including support for communication and documentation. They will work closely with Operations and Product teams in the development and maintenance of the content as it relates to scalability, functionality, and initiatives imperative to growth.

The primary focus will be concept development for DRG Coding and Clinical Validation (MS and APR) and also includes Itemized Bill Review (IBR).

What you'll do:

• Serve as subject matter expert for the Ideation Team on day-to-day activities including troubleshooting and review for data accuracy
• Review provider disputes for DRG and IBR and submit explanation of dispute rationale back to providers based on dispute findings within the designated timeframe to ensure client turnaround times are met
• Serve as a subject matter expert for content and bill reviews and provide support where needed for inquiries, training, governance and research requests
• Create and present education to Operations team and CMO along with potentially other departments on new and updated concepts, review guidelines, and dispute findings
• Research and analysis of content for Itemized Bill Review and DRG Validation
• Use of strong coding and industry knowledge to create and maintain ECR content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies, and Dispute Rationales
• Perform regulatory research from multiple sources to keep abreast of compliance enhancements and additional ECR opportunities.
• Analysis of data to assess impact for content related issues or defects. Contribute to product alerts and partner with Product Management on notifications
• Utilize the most up-to-date approved Zelis medical coding sources for ECR maintenance and development
• Partner with other areas to assess and communicate impact to the business for additions, changes, or updates as it relates to content and ECR updates
• Communicate and partner with CMO and members of Operations or Product teams regarding important changes, issues, and trends
• Ensure adherence to quality assurance guidelines
• Monitor, research, and summarize trends, coding practices, and regulatory changes
• Provide recommendations for enhancements or trends relating to content expansion, automation, and efficiencies
• Actively contribute new ideas and support ad hoc projects, including time-sensitive requests
• Collaborate with Sales, Marketing and Product on updating ECR artifacts
• Maintain awareness of and ensure adherence to Zelis standards regarding privacy

What you'll bring to Zelis:

• Bachelor's degree with 4+ years of clinical and/or medical coding experience
• Current, active CIC or CCS or equivalent credentialing is required
• RN or LPN with coding certification, or certified coder, or registered health information technician (RHIA/RHIT) with at least 6-8 years of experience
• Experience with MS-DRG/APR-DRG coding and compliance required
• Experience performing regulatory research from multiple sources, formulating an opinion, and presenting findings in an organized, concise manner
• Knowledge of National Medicare and Medicaid regulations
• Knowledge of payer reimbursement policies
• Creative problem-solving skills, leveraging insights and input from other parts of an organization
• Ability to leverage reporting tools to research claim data, trending and analysis for concept ideation processes
• Proficient in Microsoft Office Suite (Excel, PowerPoint, Word, Visio)
• Understanding of JIRA/Confluence recommended
• Strong organization and project/process management skills

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

Base Salary Range
$105,000.00 - $133,000.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.