IBR Senior Analyst

Responsibilities

• Responsible for conducting detailed review of hospital itemized bills for identification of billing and coding opportunities for all payor's claims.
• Prepare and upload documentation clearly identifying findings.
• Accurately calculate/verify the value of compliance edits and documentation for claim processing.
• Monitor multiple reports to track client specific requirements, turnaround time and overall claims progression.
• Complete claims processing after the Clinical Bill Review and Audit analysis is completed. Savings acceptance threshold not to exceed $50,000.00
• Adhere to department billing guidelines and documentation.
• Maintain audit accuracy and productivity standards per the latest requirements.
• Perform regular audits of lower-level team members for quality assurance, providing detailed feedback and education.
• Train/Develop new team members utilizing the standard operating procedures and training manual.
• Assist team members with daily claim inquiries and difficult claim processing.
• Respond to inquiries from Client Services and Provider Services in a timely manner regarding the reacceptance/revision/reprocessing of claims, claim inquiries, and appeal reviews when necessary.
• Coordinate/Manage the set up and processing of dual acceptance claims, as well as the creation and accuracy of client facing documentation.
• Maintain awareness of and ensure adherence to Zelis standards regarding privacy.
• Assist other Zelis staff members as needed, and as requested.
• What you'll bring to Zelis :
• CPC, or other coding certification, strongly preferred.
• 2-4+ years of experience within healthcare industry,
• Experienced with health/medical insurance and processing of claims.
• Expert knowledge of facility claims, billing, and reimbursement.
• Knowledge of ICD-10 and CPT coding guidelines.
• Proficient in Microsoft Office, including Outlook, Excel, and Word.
• Business writing and oral communications proficiency.
• Ability to multitask and strong attention to detail.
• Diligent research and organizational skills.
• Demonstrates solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers.
• Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue.
• Computer proficiency and technical aptitude with the ability to utilize CMS, EncoderPro, other audit software and tools, MS Office Suite.
• Thorough knowledge of company and departmental policies and procedures.
• Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.
• Location and Workplace Flexibility

Benefits

Additional Information

At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us 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. At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture. A Little About You 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. Position Overview The Itemized Bill Review Senior Analyst will be responsible for analyzing hospital claims for adherence to proper billing guidelines and will work closely with Expert Claims Review staff to efficiently adhere to policies and procedures for claims processing. This position will also be responsible for training and developing new team associates, report management, and acceptance of claims above the team members' threshold once analysis is complete. Assisting the manager and the team in areas of need will be required.

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