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Senior Edit Ideation Concept Analyst

Sapphire Digital

Sapphire Digital

St. Petersburg, FL, USA · Petersburg, VA, USA · St. Louis, MO, USA · Boston, MA, USA · Boston, MA, USA · Atlanta, GA, USA · Atlanta, GA, USA · Morristown, NJ, USA · Morristown, TN, USA · Texas, USA · Park, TX, USA
Posted on Friday, August 18, 2023

Position Overview

At Zelis, the Senior Edit Ideation Concept Analyst is responsible for development and delivery of initiatives focused on new payment integrity concept ideation for Claims Editing and Claim Review content management. The Claims Editing and Claim Review Concept Ideation Research and Documentation Team researches and produces new Claims Editing and Claim Review content as well as enhances existing Claims Editing and Claim Review content using sources (ICD-10, AHA, AMA, CPT, AAPC, CMS, clinical research sources, etc.).

The Senior Edit Ideation Concept Analyst will partner closely with the team in producing claims editing and clinical content for physician and facility claims including support for communication and documentation. Will work closely with Claims Editing and Expert Claim Review Operations and Product teams in the development and maintenance of the content as it relates to scalability, functionality, and initiatives imperative to growth.

Key Responsibilities

  • Primary focus on concept ideation for Claims Editing but may also include DRG, Itemized Bill Review (IBR) and Clinical Chart Review (CCR)

  • Serve as subject matter expert for the Concept Ideation Team on day-to-day activities including troubleshooting and review for data accuracy

  • Serve as a subject matter expert for Editing and Expert Claim Review Operations and Product Teams and provide support where needed for inquiries and research requests

  • Create and present education to Claims Editing and Expert Claim Review Teams and other departments on new and updated concepts and review guidelines

  • Research and analysis of content for Claims Editing and Expert Claim Review

  • Use of strong coding and industry knowledge to create and maintain Editing and Claim content

  • Perform regulatory research from multiple sources to keep abreast of compliance enhancements and additional claims editing and claim review opportunities

  • Support for client facing teams as needed relating to client inquiries

  • Analyze data to assess impact for content related issues or defects; contribute to product alerts and partner with Product Management on notifications

  • Partner with other areas to assess and communicate impact to the business for additions, changes, or updates as it relates to claims editing and claim review updates

  • Communicate and partner with CMO and members of Claims Editing and Claim Review Product and Operations teams regarding important changes, issues, and trends

  • Ensure adherence to quality assurance guidelines

  • Monitor, research, and summarize trends, coding practices, and regulatory changes

  • Provide recommendation 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 product artifact

Skills, Knowledge and Experience

  • RN, LPN with coding certification, OR certified coder, OR registered health information technician (RHIA/RHIT) with at least 10 years of experience

  • Previous experience with payment integrity concept ideation

  • Previous experience in analyzing large data sets

  • Experience performing regulatory research from multiple sources, formulating an opinion, and presenting findings in an organized, concise manner

  • Background and/or understanding of the healthcare industry

  • 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

  • Consistently demonstrate ability to act and react swiftly to continuous challenges and changes

  • Excellent analytical skills with data and analytics related solution

  • Good negotiation, problem solving, planning and decision-making skills


As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

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 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

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.