Zelis - Atlanta, GA

posted 2 months ago

Full-time
Remote - Atlanta, GA

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 reporting, claims management, analysis, and identifying client savings. A thorough understanding of client contractual parameters is essential for success in this role. The analyst will also be involved in the quality assurance of digitized records, ensuring that all processes align with the standards set by Zelis. In this role, the analyst will manage the screening and distribution processes of Expert Claims Review claims, supporting the end-to-end workflow audit for both Prepay and Post-pay Programs. The analyst will assist in training and onboarding new team members, ensuring that they are well-equipped to meet the performance requirements of new client claims post-implementation. A comprehensive understanding of all ECR clients, business processes, inventory management, file processes, and financial recovery tracking is necessary to effectively manage daily claims screening, distribution, and referral processes. The analyst will be accountable for the setup and processing of dual acceptance claims, as well as the creation and accuracy of client-facing documentation. It is critical that all ECR claims are managed according to client requirements, and the analyst must maintain awareness of and ensure adherence to Zelis standards regarding privacy. The role also requires collaboration with other Zelis staff members as needed, demonstrating a commitment to teamwork and operational excellence.

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 and the creation 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.
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