Job description
Position Overview:
At Zelis, the Itemized Bill Review Facility Reviewer I 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 Hospital Bill 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.
Key Responsibilities:
- 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
Skills, Knowledge, and Experience:
- CPC credential 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
As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
Zelis provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type 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.
SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.
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