About Us
Zelis is modernizing the healthcare financial experience in the United States (U.S.) 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.
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.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
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 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.
Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability and require reasonable accommodation with any part of the application and/or interview process, please email talentacquisition@zelis.com.