IBR Facility Reviewer

Position Overview

At Zelis, the Itemized Bill Review Facility Reviewer 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 Expert Claim 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.

What you'll do:

• 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

What you'll bring to Zelis:

• CPC credential preferred

• 1 - 2 years of applicable healthcare experience preferred

• 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

Base Salary Range

$59,000.00 - $75,050.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

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.

We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

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 TalentAcquisition@zelis.com.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.