IBR Facility Reviewer

At Zelis, we Get Stuff Done. So, let’s get to it!

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and TPA’s to ensure adherence to proper coding and billing guidelines. They will work closely with Expert Claim Review and Concept Development staff to efficiently identify billing errors and adhere to policies and procedures for claims processing. This is a production-based role with production and quality metric goals.

• Conduct detailed review of hospital itemized bills for identification of billing and coding errors for all payor’s claims

• Contribute process improvement and efficiency ideas to team leaders and in team meetings

• Translate client reimbursement policies into Zelis coding and clinical concepts

• Understand payor policies and their application to claims processing

• Prepare and upload documentation clearly and precisely identifying findings

• Accurately calculate/verify the value of review and documentation for claim processing

• Monitor multiple reports to track client specific requirements, turnaround time and overall claims progression

• Maintain individual average productivity standard of 10 processed claims per day

• Consistently meet or exceed individual average quality standard of 85%

• Ability to manage a variety of claim types with charges up to $500,000

• Collaborate between multiple areas within the department as necessary

• Follow standard procedures and suggest areas of improvement

• Remain current in all national coding guidelines including Official Coding Guidelines and AHA Coding Clinic and share with review team

• Maintain awareness of and ensure adherence to Zelis standards regarding privacy

• CPC credential preferred

• 1 – 2 years of applicable healthcare experience preferred

• Working knowledge of health/medical insurance and handling of claims

• General knowledge of provider claims/billing, with medical coding and billing experience

• Knowledge of ICD-10 and CPT coding

• Ability to manage and prioritize multiple tasks

• Attention to detail is essential

• Accountable for day-to-day tasks

• Excellent verbal and written communication skills

• Proficient in Microsoft Office Suite

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

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 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.

$59,000.00 - $79,000.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans,…