Contract Analyst II

Zelis • Plano, TX

2d • Hybrid

About The Position

At Zelis, we Get Stuff Done. So, let’s get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview Job Summary: This position requires an incumbent to analyze healthcare reimbursement contracts and load contract terms between payers and providers in an accurate and timely manner using proprietary software. This position reports to the Manager of Contract Configuration and will collaborate with the programming and development teams in the creation and vetting of calculation methods, database loads, or changes. This position is an internal resource to staff and clients and as such is expected to respond to client issues and cases in a timely manner.

Requirements

• Bachelor’s Degree or equivalent work experience in Healthcare Revenue Cycle Management/Contracting field
• Microsoft product proficiency. Must be an intermediate to expert user of Excel
• Posses strong analytical and math skills
• Self Motivated and Detail Oriented
• Effective written and verbal skills, communicate effectively & expresses ideas clearly and succinctly.
• Develops Self: Seeks opportunities for continuous learning. Modifies behavior in response to feedback. Knows personal strengths and weaknesses and demonstrates ownership for personal development.
• Drives for Results: Delivers high quality work and attains results. Demonstrates personal drive and pushes self and others for results and quality work. Responds appropriately to urgent situations.
• Plans and Organizes Effectively: Prioritizes the importance of tasks and goals. Manages time efficiently to accomplish priorities and overcome obstacles.
• Displays Adaptability: Performs well in high pressure or stressful situations. Works effectively when direction is unclear or rapidly changing. Demonstrates persistence in the face of obstacles.

Responsibilities

• Set up basic contract loads: simple single case agreements (SCAs), basic % of billed charges (BCs), basic % of Medicare, general carve-out codes and basic fee schedule set up.
• Interpret complex contract terms, analyze reimbursement methodologies, and rate structures (e.g., DRG, APC, CPT/HCPCS, ICD-10).
• Load, maintain, and audit client contracts within the adjudication system.
• Validate and test contract configurations for claims pricing accuracy.
• Maintain fee schedule in contract databases and apply annual escalators for client auto renewals.
• Link contracts to payer products, update and maintain provider groups within client databases to ensure seamless claims routing.
• Handles confidential material on a regular basis and is responsible for protecting the confidentiality of such information within the established guidelines of Company and law. (HIPAA Compliance)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees