Position Overview:

As part of the Price Optimization division, this role assists the Manager with operational leadership over the Document Retrieval Department. The supervisor will be responsible for managing the Document Retrieval I staff and monitoring the effectiveness of the process to request and obtain billing documents as well as provide training/mentorship for Document Retrieval I staff.

What you will do:

• Manages DR I team who assist the nurse auditors in the medical claim audit process by requesting UB/IBs applicable for pre-pay and post -pay documents from medical providers nationwide.

• Monitor and Audit DR I’s on outstanding claims and quality of uploads

• Assist with inventory assignment for all team members

• Provide new hire training and mentors’ new staff on proper claims processing.

• Manage and monitor team production and goals for DR I; ensuring quality standard are met to ensure accuracy in documents received and uploaded

• Coach and mentor DR I team members on exceeding expectations, evaluate performance on an ongoing basis and is responsible for monthly feedback to team and for conducting annual performance reviews

• Serve as a source of reference and escalation for questions, clarification and resolution for DR I team

• Participate in the hiring of new hires.

• Conducts payroll and WorkDay management responsibilities for DR I.

• Meets or exceeds Quality Objectives established by the DR department.

• Process all outside record retrieval portals for submission, downloads and logging

• Responsible for maintaining special work queues (i.e. Air ambulance, Nurse manager)

• Identifies and participates in Process Improvement Initiatives. Offers concrete recommendations for process improvement.

• Collaborate with Manager on DR Operations

• Meet with the leadership on a weekly/monthly basis to report overall functions of the department

• Partner with other Business Leaders to establish workflow efficiencies and resolve escalated/priority items with appropriate urgency

• Performs other related responsibilities as assigned.

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

What you will bring:

• Associate’s degree or equivalent work experience within Payment Integrity

• 2+ years of medical claim experience

• Direct people management of a complex team of individuals; Hires, promotes, assess performance and other people’s decisions, coached, mentors, role models of company values, role models diversity, inclusion and wellness

• Knowledge of provider billing processes and techniques in obtaining documents

• Knowledge of itemized billing and HCFA claim documents

• Management of strategic operational and technology initiatives. Experience managing projects and process innovative changes effectively.

• Strong working knowledge of MS Excel, computer systems, applications and operating systems.

• Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.

• Excellent customer service and telephone skills.

• Demonstrated thought leadership and motivation skills, a self-starter with an ability to research and resolve issues

• Excellent skills in critical thinking and analysis, project management, meeting facilitation, and interpersonal interactions (e.g., partnering, conflict management, consulting, etc.)

• Ability to manage and prioritize multiple tasks

• Ability to work under pressure and meet deadlines

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.

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 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

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