Bill Review Operations Analyst

Zelis - Morristown, NJ

Full-time

Remote - Morristown, NJ

About the position

The Bill Review Operations Analyst at Zelis NA plays a crucial role in providing operational support to the Expert Claims Review team. This position involves a variety of responsibilities including itemized bill review, clinical chart review, and document retrieval. The analyst will be responsible for managing the screening and distribution processes of Expert Claims Review claims, ensuring that the end-to-end workflow for both Prepay and Post-pay Programs is efficient and effective. This role requires a thorough understanding of client contractual parameters and the ability to analyze claims management processes to identify client savings opportunities. In addition to operational support, the Bill Review Operations Analyst will assist in training and onboarding new team members, ensuring that they are well-equipped to meet the performance standards set by the company. The analyst will monitor new client claims post-implementation to ensure compliance with client requirements and high performance. A key aspect of this role is the accountability for the deployment of resources for daily claims screening, distribution, and referral processes, which includes managing ECR and ECR-EDI claims, DRG validation, and Out-of-Network report management. The analyst will also be responsible for setting up and processing dual acceptance claims, as well as creating and maintaining accurate client-facing documentation. Adherence to Zelis standards regarding privacy and confidentiality is paramount, and the analyst will be expected to assist other staff members as needed. This position requires a solid understanding of screening and audit techniques to identify revenue opportunities, as well as proficiency in training techniques to maximize savings and revenue for the company.

Responsibilities

• Manage the screening and distribution processes of Expert Claims Review claims.
• 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.
• Responsible for the setup and processing of dual acceptance claims, as well as the creation and accuracy of client-facing documentation.
• Ensure 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.

Requirements

• 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 and verbal communication skills.
• Strong prioritizing and organizational skills.
• Excellent typing/data entry skills.
• Strong working knowledge of Microsoft Office suite as well as Adobe Acrobat.