DRG Ops Analyst

Position Overview

The DRG Operations Analyst will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams.  Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters.

What you'll do:

• Managing the screening and distribution processes of Expert Claim Review Claims supporting the end-to-end workflow audit for Zelis Prepay and Post-pay Programs.

• Assist with training and onboarding of new team members.

• Monitor new client claims post-implementation to ensure high performance per client requirements.

• Thoroughly understand all ECR clients, business processes, inventory management, file processes, and financial recovery tracking.

• Accountable for the deployment of resources for the management of daily claims screening, distribution, and referral processes, including ECR and ECR-EDI, DRG Validation and DRG Outlier pricing.

• Accountable for ensuring all ECR claims are managed per client requirements.

• Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

What you'll bring:

• High School Diploma required. Associate degree preferred.

• 2+ years of experience within the healthcare industry preferred.

• Solid written & verbal communication skills.

• Strong prioritizing & organizational skills.

• Excellent typing/data entry skills.

• Experience in claim processing, medical billing, or related a plus.

• Strong working knowledge of Microsoft Office suite as well as Adobe Acrobat.

Base Salary Range

$54,000.00 - $68,400.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity  
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. 
 
We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. 

Accessibility Support 
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email [email protected]. 

  

Disclaimer 

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.