Zelis is a healthcare information technology company and market-leading provider of end-to-end healthcare claims cost management and payment solutions.
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.
Zelis is pursuing an aggressive organic and non-organic growth strategy focused on providing superior healthcare claim lifecycle solutions to payors, providers and individuals from pre-payment through payment. As the company executes its growth strategy, Zelis is seeking to identify an accomplished Systems Integration Specialist. Reporting directly to the Director of Integrations, and working closely with managers and other team members.
? Responsible for the integration/implementation of new client accounts by utilizing an EDI interface which may be a currently supported file format (flat file, 835, etc) or a new file format
? Utilize SQL to analyze data to ensure a defect free integration/implementation process.
? Utilize SQL to update system configuration data across multiple client environments\
? Troubleshoot client issues including but not limited to: file structure, data integrity, load failures, and file transmission failures while utilizing tools such as Linq or T-SQL, to research and correct. The issues could occur in the clients UAT or Production environments
? Participate in client calls and provide solutioning to technical issues that may arise. Must be able to communicate solutions in a manner suitable for client consumption
? Responsible for the implementation of any new vendor relationship using Electronic Data Interchange. Supports and Educates operations team regarding technologies used and workflow.
? Data mining analysis to identify root cause behind trends and drivers which could impact daily production, Payments market penetration and revenue streams.
? Document change specifications for development teams then execute user acceptance testing
? Perform steps necessary to transition clients from TEST environment to PRODUCTION environment
? Maintain awareness of and ensure adherence to Payments standards regarding HIPAA and other privacy concerns.
? Provide recommendations to improve processes, data platforms, reporting and analytic methods
Technical Skills / Knowledge:
Has solid understanding of software implementation processes, Health Insurance Claim Adjudication partners and their clients
Has solid technical understanding of EDI files (fixed length, delimited, XML and EDI 835) and health insurance claim adjudication systems
Has solid technical understanding of SQL complex queries, take and verify, read and edit data collection techniques
Computer proficiency and technical aptitude with the ability to utilize SQL DBMS, various connectivity solutions (FTP/Secure FTP), VPN
CMS, EDI/X12 plus use of MS Office applications.
Works on assignments that are complex in nature in which judgment and initiative are required in resolving problems and making recommendations
Customary Education and Experience:
Experience working in a SQL DBMS environment required
Familiar with common types of connectivity solutions (FTP/Secure FTP), VPN)
Experience with different file formats (fixed length, delimited, XML and EDI 835) required
4-year college degreepreferred
Project management experiencepreferred
Experience with SSIS for data extraction a plus
Health insurance claim adjudication knowledge a plus
3+ years experience in a related field is required