Client Business Analyst

Position Overview The Client Business Analyst (CBA) will be responsible for monitoring, analyzing, summarizing and presenting data for all assigned editing clients. The Client Business Analyst will work as part of the Client Policy Integration team to provide monthly performance summaries which includes but is not limited to trends, edit utilization, outliers and impact of requested edit customizations. This role will provide a major contribution enhancing the overall capacity of the Client Policy Integration team to meet the key performance goals for client edit adoption and revenue optimization.

The Client Business Analyst will ensure day-to-day activities align with the overall mission and adherence to best practice policies. ESSENTIAL FUNCTIONS : Demonstrate an expert level understanding of all Zelis editing products with an ability to clearly articulate correct coding/claim adjudication guidelines, and interpretation of client policies. Perform revenue optimization analysis for Zelis editing products and assigned accounts as defined by the business unit (external and internal customers).

Demonstrate expertise in auditing claims processes and edit performance validation with ability to document root-cause analysis for escalation and resolution. Partner with Client Integration Specialist team to support the implementation of the Zelis editing product which includes but is not limited to data review, interpreting client policies, guidance for requested client customizations and support testing and client “go-live”. Support the research/validation of new edit concepts, pre-production data analysis, determine client selection based on edit volume/potential savings opportunity and support new edit communication/rollout strategies.

Critically evaluate information gathered from multiple sources, reconcile conflicts and provide a synopsis of findings Weekly, monthly and quarterly client financial KPI analysis; monitor client trends, work with assigned teams to report/escalate issues that would affect daily business operations. Proactively escalate identified claim adjudication issues utilizing all tools and resources to document and resolve Perform monthly performance analysis with detailed summary for edit trends, utilization, adoption, opportunity pipeline, revenue variances and forecasting. Conduct ad hoc analysis as requested per assigned clients.

Assist in project management of financial forecasting, budgeting and trend analysis details. Work with assigned aforementioned teams to design and build reports/templates to present monthly performance trends to assigned clients/internal teams. Completes all responsibilities as outlined on annual Performance Plan Completed all special projects and other duties as assigned Ensure compliance with HIPAA regulations and requirements. undefined Education Qualification Graduate 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.