Bill Review Operations Analyst

Position Overview:

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

Key Responsibilities:

• Manage the screening and distribution processes of Expert Claims Review claims and support 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, ECR Distribution, and support for Out-of-Network report management.

• Responsible for the set up and processing of dual acceptance claims, as well as the creation and accuracy of client facing documentation.

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

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

• Assist other Zelis staff members as needed, and as requested.

Technical Skills / Knowledge:

• Demonstrates a solid understanding of screening and audit techniques for identifying revenue opportunities.

• Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue.

• Computer proficiency and technical aptitude with the ability to utilize CMS and MS Office Suite.

• Development and adherence to department SOP’s.

• Thorough knowledge of company and departmental policies and procedures.

• Act as subject matter experts to various departments

Independence/ Accountability:

• Maintain personal and department production and financial goals.

• Requires minimal daily supervision.

• Ability to make decisions based on established guidelines and gained knowledge of HBR departments and client standards.

• Regularly reviews goals and objectives with the supervisor.

• Ability to follow detailed instructions on new assignments.

• Accountable to day-to-day tasks.

• Must be professional and respect the confidentiality of administrative matters and files.

• Ability to manage and prioritize multiple tasks.

• Ability to work under pressure and meet deadlines.

Professional Experience:

• High School Diploma required. Associate’s degree in related field preferred.

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

• Experience with health/medical insurance and processing of claims.

• Solid written & verbal communication skills.

• Strong prioritizing & organizational skills.

• Excellent typing/data entry skills.

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

Location and Workplace Flexibility: 

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

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Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

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.

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 encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

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].

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