Team Lead, Data Analysis

objECTIVES AND RESPONSIBILITIES:  

• Supervises, coaches, and develop staff to ensure operational department expectations are met. 

• Regularly communicate any updates or changes in processes and documentation to all relevant team members, ensuring that the entire team is informed and aligned. 

• conducts weekly individual team meetings when necessary to advise departmental updates. 

• Assists in monitoring team and individual performance and KPIs to identify trends. Review and document staffing levels; coordinate Teams coverage to ensure operational deliveries are met. 

• Plans, coordinates, and organizes weekly reporting, monthly 1:1’s, and annual reviews. 

• Partners with recruiting and other matrix supervisors related to interviewing and hiring to ensure that our department is staffed with the best possible talent.  

• Reviews and handles timecard approvals and time off requests. 

• Respond and resolve escalated issues and assigned projects.  

• Improve operational management systems, processes, and best practices. 

• 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 test scenarios align 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. 

• Produce documents that are 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 Will bring: 

• Aptitude for problem-solving with technical skills to execute 

• 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 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. 

education: 

• 2-3 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 and interpret claim editing rules. 

• 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. 

• Excellent written, oral and presentation skills and ability to communicate complex concepts. 

• Proficient in Microsoft Office, Word, Excel.