Medicaid Pricer Regulatory Analyst

Position Overview

The Medicaid Regulatory Pricer Analyst is an entry-level role within the Zelis Regulatory Pricer Product team. This position supports senior analysts by performing foundational research, executing routine data updates, and assisting with documentation and quality assurance activities. The analyst will begin building subject-matter expertise in Medicaid reimbursement as well as institutional and professional payment methodologies.
This role is ideal for individuals early in their healthcare, regulatory, or data analysis career who are eager to learn complex reimbursement concepts and contribute to accurate and compliant pricing system operations.

Essential Duties & Responsibilities

• Regulatory Research & Support

• 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.

• Pricing Updates & Documentation

• 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).

• Data Analysis, Validation, Quality Assurance & Testing

• 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.

• Cross-Team Communication & Support

• 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.

• Other Responsibilities

• Perform additional duties as assigned to support team and organizational goals.

Qualifications

• 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

Education:

• 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.

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.