Job Description
- CPC credential preferred.
- Detailed review of hospital bills for errors.
- Knowledge of ICD-10 and CPT coding.
- Proficient in Microsoft Office Suite.
- Excellent verbal and written communication skills.
About Us
Zelis is modernizing the healthcare financial experience in the United States (U.S.) by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers in the U.S. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts—driving real, measurable results for clients.
Why We Do What We Do
In the U.S., consumers, payers, and providers face significant challenges throughout the healthcare financial journey. Zelis helps streamline the process by offering solutions that improve transparency, efficiency, and communication among all parties involved. By addressing the obstacles that patients face in accessing care, navigating the intricacies of insurance claims, and the logistical challenges healthcare providers encounter with processing payments, Zelis aims to create a more seamless and effective healthcare financial system.
Zelis India plays a crucial role in this mission by supporting various initiatives that enhance the healthcare financial experience. The local team contributes to the development and implementation of innovative solutions, ensuring that technology and processes are optimized for efficiency and effectiveness. Beyond operational expertise, Zelis India cultivates a collaborative work culture, leadership development, and global exposure, creating a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we foster a holistic workplace experience. Additionally, the team plays a vital role in maintaining high standards of service delivery and contributes to Zelis’ award-winning culture.
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
- 1 – 2 years of applicable healthcare experience preferred
- Graduate
- 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
