UAT Analyst, Payment Integrity

Position Overview :

The UAT Analyst will be responsible for creating test plan, test scenarios, setup, execution of UAT testing and reviewing results for all healthcare claim editing related projects within the Payment Integrity department including but not limited to the testing of new data driven edits, configuration, platform initiatives, and UI initiatives.

What you'll do :

Perform end to end testing to ensure appropriate functionality, product integrity, accuracy, and quality of all changes and enhancements of the edit platform, Data Driven Edits PriZem (in-house system), Visium through the Payment Integrity (Claims Editing) process.

Analyze clinical and technical requirements and define the scope of UAT testing. Setup, develop and maintain detailed test scenarios, test suites, data, checklist and / or other documents as specified, ensuring scenarios are directly aligned to requirements, adhering to claim adjudication guidelines. While using best practices for software testing methodology and techniques.

Analyze and troubleshoot erroneous results, determine root cause, and suggest solutions.

Ensure test scenario documentation is detailed, accurate and in a consistent format, demonstrating strong analytical and documentation skills.

Continuous improvement and refinement of tests-based pre-production validation, post-production results and feedback from other groups (Configuration Department, Content Department and Operations teams) as needed.

Support multiple projects, initiatives, tasks, and maintenance releases while adhering to deadlines.

Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

What you'll bring to Zelis :

5 years of relevant experience or equivalent combination of education & work within healthcare payer or provider.

Knowledge of healthcare reimbursement methodologies and acceptable billing practices.

Knowledge of payer reimbursement policies, state and federal regulations and applicable industry standards.

Knowledge of claims adjudication process, interpret claim editing rules, including adjusted and corrected claims.

Certified coder (CCS, CCS-P or CPC), or registered health information technician (RHIA / RHIT), or RN, LPN with coding knowledge a plus.

Understanding of SQL Server 2000 / 2005 / 2008 is a plus.

Project management experience a plus.

Proficient in Microsoft Office, Word, Excel.

Highly organized and results driven.

Excellent problem solving and analytical skills.

Ability to prioritize and manage multiple concurrent projects.

Ability to work through others without direct supervisory responsibility within departments and across the organization.

Understanding of medical coding and medical claims.

Understanding of the life of a claim, including adjusted / corrected claims.

Excellent attention to detail to assess issues and resolve in a timely manner.

Basic database skills using MS SQL.

Ability to identify key factors and decisions that will make a project successful.

Ability to see the big picture and learn new processes, technologies and envision how they could benefit Zelis.

Must have excellent communication and presentation skills to effectively interface with team members and ability to communicate complex concepts.

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.

Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients.

Commitment to Diversity, Equity,Inclusion, and Belonging

At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity

Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and / or interview process, please email TalentAcquisition@zelis.com.

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