Medicaid Pricer Regulatory Analyst Job at Zelis (Hyderabad)

Job Responsibility

Perform basic research on Medicaid regulations, state bulletins, and published fee schedules under the guidance of senior team members
Summarize regulatory findings and assist in interpreting requirements for internal use
Assist in maintaining pricing logic and configuration by performing routine updates and data entry tasks
Help draft or update procedural documentation, SOPs, and reference materials
Contribute to the creation of user story components (e.g., requirements outlines, rule summaries)
Use Excel or internal tools to conduct comparisons, calculations, and data-driven validation
Support the preparation of sample claims and expected outcomes for testing and QA
Participate in system testing by executing test cases and documenting results
Assist in identifying potential issues or discrepancies in pricing outputs and escalating to senior analysts
Collaborate with internal teams—including Development, QA, and Client Services—to clarify questions and support project work
Provide general operational support to senior analysts on assigned Medicaid payment systems
Perform additional duties as assigned to support team and organizational goals

Interest in developing knowledge of reimbursement methodologies and applicable regulatory frameworks
Strong attention to detail with the ability to accurately interpret written material
Effective written and verbal communication skills with the ability to convey information clearly and concisely
Strong multitasking and time-management skills in deadline-driven environments
Strong critical thinking skills to evaluate issues, identify solutions, and support data-driven decision-making
Working knowledge of Microsoft Excel with experience using formulas, lookups, and data comparison tools
Working knowledge of public and private healthcare payment systems, medical claims, standard claim coding, claim editing, contracting, and provider networks
Working knowledge of MS SQL Server Studio a plus
4 years of relevant experience or equivalent combination of education & work within healthcare payer or provider
Knowledge of healthcare reimbursement methodologies, claim coding 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
Excellent written, oral and presentation skills and ability to communicate complex concepts
Proficient in Microsoft Office, Word, Excel

Working knowledge of MS SQL Server Studio
Certified coder (CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT), or RN, LPN with coding knowledge