Operations Analyst

Zelis - Plano, TX

Full-time - Entry Level

Remote - Plano, TX

About the position

The Operations Analyst will provide essential daily operational support to the Expert Claims Review (ECR) team, which encompasses various functions such as itemized bill review, clinical chart review, and document retrieval. This role is pivotal in ensuring the smooth operation of claims management processes, including reporting, analysis, and client savings identification. The Operations Analyst will also be responsible for the quality assurance of digitized records and must possess a comprehensive understanding of client contractual parameters. Key responsibilities include managing the screening and distribution processes of Expert Claims Review claims, supporting the end-to-end workflow audit for both Zelis Prepay and Post-pay Programs, and assisting with the training and onboarding of new team members. The analyst will monitor new client claims post-implementation to ensure they meet high performance standards as per client requirements. A thorough understanding of all ECR clients, business processes, inventory management, file processes, and financial recovery tracking is essential. The Operations Analyst will be accountable for deploying resources effectively to manage daily claims screening, distribution, and referral processes, including ECR and ECR-EDI, DRG validation, and support for Out-of-Network report management. Additionally, the role involves setting up and processing dual acceptance claims and ensuring the accuracy of client-facing documentation. The analyst must maintain awareness of and ensure adherence to Zelis standards regarding privacy and assist other staff members as needed.

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.
• Understand all ECR clients, business processes, inventory management, file processes, and financial recovery tracking.
• Deploy resources for the management of daily claims screening, distribution, and referral processes, including ECR and ECR-EDI, DRG validation, and ECR Distribution.
• Set up and process dual acceptance claims and ensure the 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 a 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 and Adobe Acrobat.
• Demonstrates a solid understanding of screening and audit techniques for identifying revenue opportunities.
• Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue.
• Ability to make decisions based on established guidelines and gained knowledge of HBR departments and client standards.

Nice-to-haves

• Experience in a leadership role or guiding lower-level personnel.
• Familiarity with CMS and MS Office Suite.
• Experience in project management.

Benefits

• Hybrid and remote-friendly work culture.
• Flexible work locations based on position needs.
• Commitment to diversity, equity, inclusion, and belonging.
• Equal Employment Opportunity policies.