IBR Facility Reviewer at Zelis

At Zelis we Get Stuff Done. So lets get to it!A Little About UsZelis 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.A Little About YouYou 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 youve learned along the way. You are more than just your resume; you are a reflection of your achievements the knowledge youve gained and the personal interests that shape who you are.Position OverviewAt Zelis the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and TPAs 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.What youll do:Conduct detailed review of hospital itemized bills for identification of billing and coding errors for all payors claimsContribute process improvement and efficiency ideas to team leaders and in team meetingsTranslate client reimbursement policies into Zelis coding and clinical conceptsUnderstand payor policies and their application to claims processingPrepare and upload documentation clearly and precisely identifying findingsAccurately calculate/verify the value of review and documentation for claim processingMonitor multiple reports to track client specific requirements turnaround time and overall claims progressionMaintain individual average productivity standard of 10 processed claims per dayConsistently meet or exceed individual average quality standard of 85%Ability to manage a variety of claim types with charges up to $500000Collaborate between multiple areas within the department as necessaryFollow standard procedures and suggest areas of improvementRemain current in all national coding guidelines including Official Coding Guidelines and AHA Coding Clinic and share with review teamMaintain awareness of and ensure adherence to Zelis standards regarding privacyWhat youll bring to Zelis:CPC credential preferred1 2 years of applicable healthcare experience preferredWorking knowledge of health/medical insurance and handling of claimsGeneral knowledge of provider claims/billing with medical coding and billing experienceKnowledge of ICD-10 and CPT codingAbility to manage and prioritize multiple tasksAttention to detail is essentialAccountable for day-to-day tasksExcellent verbal and written communication skillsProficient in Microsoft Office SuitePlease note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.Location and Workplace FlexibilityWe 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 employees work locations are based on the needs of the position and determined by the Leadership -office work and activities if applicable vary based on the work and team objectives in accordance with Company policies.Base Salary Range$59000.00 - $79000.00At 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 commissions or other incentives depending on the role.Zelis full-time associates are eligible for a highly competitive benefits package as well which demonstrates our commitment to our employees health well-being and financial protection. The US-based benefits include a 401k plan with employer match flexible paid time off holidays parental leaves life and disability insurance and health benefits including medical dental vision and prescription drug coverage.Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment 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.We welcome applicants from all backgrounds and encourage you to apply even if you dont meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.Accessibility SupportWe are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process please email .DisclaimerThe above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities duties and skills from time to time. Key Skills Facilities Management,Banking,Content Writing,Customer Support,Fun,Airlines Employment Type : Full-Time Experience: years Vacancy: 1 Monthly Salary Salary: 59000 - 79000