Concept Development Analyst
Core
Develop and maintain clinical content for editing physician and facility claims, ensuring compliance with medical coding standards and regulations.
Role type
Mid-level healthcare claims editing content analyst
Builds
Clinical content rules and edits for claims processing
Domain
Healthcare / Medical Coding / Insurance Claims
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical coding knowledge, Regulatory research, Data analysis, Project management, Quality assurance, Trend analysis
Preferred skills
Graduate degree, AAPC/AHIMA certification, Healthcare industry background, Medicare/Medicaid regulation knowledge, Payer reimbursement policy knowledge
Technologies
ICD-10, AHA, AMA, CPT, AAPC, CMS
Responsibilities
Research and produce new edits and claim review content; Perform regulatory research from multiple sources; Analyze data to assess impact of content issues; Monitor and summarize trends in coding practices and regulatory changes; Partner with Product teams on content updates and business impact; Ensure adherence to quality assurance guidelines and Zelis privacy standards.
Seniority
Mid-level, hands-on IC
