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Itemized Bill Review Supervisor

Zelis

Zelis

People & HR, Operations
Morristown, NJ, USA · Morristown, TN, USA · Texas, USA · Boston, MA, USA · Boston, MA, USA · St. Petersburg, FL, USA · Petersburg, VA, USA · Atlanta, GA, USA · Atlanta, GA, USA · Missouri, USA
Posted on Friday, August 11, 2023

Position Overview:

At Zelis, the Itemized Bill Review (IBR) Supervisor, drives management and development of coding reviews within the Hospital Bill Review department. This will include researching current coding denials and identifying and implementing new concepts to drive deeper savings. Focus will be on analyzing and executing current business and new initiatives; establishing metrics to track changes; and managing a small team while ensuring work priorities are followed. The Itemized Bill Review Supervisor, will serve as the Subject Matter Expert on coding within the Hospital Bill Review Department. This will include creating and implementing program policies and procedures to ensure best practices, and performing quality assurance reviews to ensure the team is capturing all potential saving opportunities. The Itemized Bill Review Supervisor, will investigate areas of coding opportunities within the current product and be responsible for recommending and documenting new opportunities, conducting training, and tracking performance impacts.

Hiring remotely at locations below:

•Atlanta, GA

•Boston, MA

•Morristown, NJ

•St Louis, MO

•St Pete, FL

Plano, TX

Objectives and Responsibilities:

  • Manage level I IBR Reviewers with focus on key daily operational tasks
  • Monitor multiple reports to track client specific requirements, turnaround time, and overall claims progression
  • Accurately calculate the value of review and documentation for claim processing
  • Provide ongoing team education regarding coding and/or billing concepts through Quality Assurance reviews
  • Evaluate current workflow processes and implement recommended changes for efficiency and effectiveness
  • Conduct onboarding and training of new team members
  • Perform detailed review of facility itemized bills for savings opportunities
  • Monitor, research, and summarize changes regarding revised client reimbursement policies or expectations
  • Maintain Standard Operating Procedures for department
  • Identify whitespace in current projects related to coding reviews and create strategy to close the gap
  • Implement new IBR concepts including responsibility for research, ROI analysis, client support documents, and development of training materials
  • Present IBR results with supporting references to clients and providers as necessary
  • Assist in appeals process as needed
  • Collaborate with multiple areas within the department
  • Push initiatives from inception to completion
  • Work closely with Hospital Bill Review Leadership in departmental functions and special projects
  • Maintain awareness of and ensure adherence to Zelis standards regarding privacy

What you will bring:

Technical Skills / Knowledge:

  • Demonstrated ability to lead a team is strongly preferred
  • Understanding of Medicare, Medicaid, and Commercial guidelines, as well as an understanding of health plans and lines of business in addition to their interaction with policies and coding guidelines
  • Expertise regarding audit techniques, identification of revenue opportunities, and financial negotiation with providers
  • Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue
  • Computer proficiency and technical aptitude, including MS Office and the ability to utilize audit software and tools

Independence/Accountability:

  • Minimal daily supervision required
  • Ability to follow detailed instructions on new assignments
  • Accountable to day-to-day tasks
  • Outstanding ability to manage and prioritize multiple tasks
  • Ability to work under pressure and meet deadlines

Problem Solving:

  • Ability to make logical suggestions as to likely causes of problems and independently recommend solutions
  • Excellent organizational skills to prioritize responsibilities and complete work in a timely fashion
  • Excellent project management skills, ensuring proactive follow up and efficient completion of tasks
  • Attention to detail and concern for impact

Education:

  • Coding certification (CPC, CCS, CIC) and/or RN licensure required
  • 3-5 years applicable healthcare experience preferred

#LIRZ1

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

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 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 TalentAcquisition@zelis.com

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.