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Operations Analyst, DRG
2 months ago
The Operations Analyst will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters.
Key responsibilities:
- Managing the screening and distribution processes of Expert Claim Review Claims supporting the end-to-end workflow audit for Zelis Prepay and Post-pay Programs.
- Assist with training and onboarding of new team members.
- Monitor new client claims post-implementation to ensure high performance per client requirements.
- Thoroughly understand all ECR clients, business processes, inventory management, file processes, and financial recovery tracking.
- Accountable for the deployment of resources for the management of daily claims screening, distribution, and referral processes, including ECR and ECR-EDI, DRG Validation and DRG Outlier pricing.
- Accountable for ensuring all ECR claims are managed per client requirements.
- Maintain awareness of and ensure adherence to Zelis standards regarding privacy.
- Associate or Bachelor's degree preferred.
- 2+ years of experience within the healthcare industry preferred.
- Solid written & verbal communication skills.
- Strong prioritizing & organizational skills.
- Excellent typing/data entry skills.
- Experience in claim processing, medical billing, or related a plus.
- Strong working knowledge of Microsoft Office suite as well as Adobe Acrobat.
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.
Commitment to Diversity, Equity,Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All 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 encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.
Accessibility Support
We 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
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.
