Healthcare Operations Specialist

7 days ago


Étreux, Hauts-de-France, United States Zelis Full time

Company Overview: Zelis is a leading healthcare technology company that enables payers to deliver efficient and personalized payment experiences to their members.

Salary: $60,000 - $80,000 per year, depending on experience.

About the Role

The Bill Review Operations Analyst will play a critical role in supporting the Expert Claims Review team by providing daily operational support. Key responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters.

Key Responsibilities

  • Manage the screening and distribution processes of Expert Claims Review claims and support 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, ECR Distribution, and support for Out-of-Network report management.
  • Responsible for the setup and processing of dual acceptance claims, as well as the creation and accuracy of client-facing documentation.
  • Accountable for ensuring all ECR claims are managed per client requirements.
  • Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

Required Skills and Qualifications

  • Demonstrates a solid understanding of screening and audit techniques for identifying revenue opportunities.
  • 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 and MS Office Suite.
  • Development and adherence to department SOPs.
  • Thorough knowledge of company and departmental policies and procedures.

Benefits

  • Maintain personal and department production and financial goals.
  • Requires minimal daily supervision.
  • Ability to make decisions based on established guidelines and gained knowledge of HBR departments and client standards.

Professional Experience

  • High School Diploma required. Associate's degree in related field preferred.
  • 2+ years of experience within the healthcare industry preferred.
  • Experience with health/medical insurance and processing of claims.


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