Position Overview:

The Itemized Bill Review Senior Analyst will be responsible for analyzing hospital claims for adherence to proper billing guidelines and will work closely with Hospital Bill Review staff to efficiently adhere to policies and procedures for claims processing. This position will also be responsible for training and developing new team associates, report management, and acceptance of claims above the team members’ threshold once analysis is complete. Assisting the manager and the team in areas of need will be required.

Key Responsibilities:

• Responsible for conducting detailed review of hospital itemized bills for identification of billing and coding opportunities for all payor’s claims.
• Prepare and upload documentation clearly identifying findings.
• Accurately calculate/verify the value of compliance edits and documentation for claim processing.
• Monitor multiple reports to track client specific requirements, turnaround time and overall claims progression.
• Complete claims processing after the Clinical Bill Review and Audit analysis is completed. Savings acceptance threshold not to exceed TBC $500,000.00 / $50,000.00
• Adhere to department billing guidelines and documentation.
• Maintain audit accuracy and productivity standards per the latest requirements.
• Perform regular audits of lower-level team members for quality assurance, providing detailed feedback and education.
• Train/Develop new team members utilizing the standard operating procedures and training manual.
• Assist team members with daily claim inquiries and difficult claim processing.
• Respond to inquiries from Client Services and Provider Services in a timely manner regarding the reacceptance/revision/reprocessing of claims, claim inquiries, and appeal reviews when necessary.
• Coordinate/Manage the set up and processing of dual acceptance claims, as well as the creation and accuracy of client facing documentation.
• Maintain awareness of and ensure adherence to Zelis standards regarding privacy.
• Assist other Zelis staff members as needed, and as requested.

Professional Experience:

• CPC, or other coding certification, strongly preferred.
• Experienced with health/medical insurance and processing of claims.
• Expert knowledge of facility claims, billing, and reimbursement.
• Knowledge of ICD-10 and CPT coding guidelines.
• Proficient in Microsoft Office, including Outlook, Excel, and Word.
• Business writing and oral communications proficiency.
• Ability to multitask and strong attention to detail.
• Diligent research and organizational skills.

Job Requirements:

Technical Skills / Knowledge:

• Demonstrates solid understanding of 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 with the ability to utilize CMS, EncoderPro, other audit software and tools, MS Office Suite.
• Thorough knowledge of company and departmental policies and procedures.

Independence/ Accountability:

• Maintain personal production and savings quota.
• Requires minimal daily supervision.
• Regularly reviews goals and objectives with supervisor.
• Ability to follow detailed instructions on new assignments.
• Accountable to day-to-day tasks.
• Must have professional manner and respect the confidentiality of administrative matters and files.
• Ability to manage and prioritize multiple tasks.
• Ability to work under pressure and meet deadlines.

Problem Solving:

• Makes logical suggestions as to likely causes of problems and independently recommends solutions.
• Excellent organizational skills are required to prioritize responsibilities, thus completing work in a timely fashion.
• Outstanding ability to multiplex tasks as required.
• Excellent project management skills.
• Attention to detail and concern for impact is essential.

Leadership Activities:

• Provides guidance to lower-level personnel.
• Regularly attends meetings and leads training sessions.
• Must be proactive to ensure proper follow up and completion of projects.
• Must maintain a professional demeanor in sensitive situations.
• Assists other departments as necessary.

Communication Skills:

• Must work well with others.
• Effectively communicate with others by giving and receiving feedback.
• Communicates ideas and information clearly.
• Must have excellent communication and presentation skills to effectively interface with the entire staff, and external representatives from the business, financial, legal, and scientific communities.

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.