Operations Analyst

Position Overview

The Operations Analyst will provide daily operational support to the Itemized Bill Review team, including the itemized bill review, clinical chart review, and document retrieval teams. 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 Itemized Bill 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 IBR 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 IBR and IBR-EDI, DRG validation, IBR Distribution, and support for Out-of-Network report management.

• Responsible for the set up and processing of dual acceptance claims, as well as the creation and accuracy of client facing documentation.

• Accountable for ensuring all IBR claims are managed per client requirements.

• Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

• Assist other Zelis staff members as needed, and as requested.

JOB REQUIREMENTS:

Technical Skills / Knowledge:

• 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 SOP’s.

• Thorough knowledge of company and departmental policies and procedures.

• Act as subject matter experts to various departments

Independence/ Accountability:

• 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.

• Regularly reviews goals and objectives with the supervisor.

• Ability to follow detailed instructions on new assignments.

• Accountable to day-to-day tasks.

• Must be professional and respect the confidentiality of administrative matters and files.

• Ability to manage and prioritize multiple tasks.

• Ability to work under pressure and meet deadlines.

Problem Solving:

• Makes logical suggestions for likely causes of problems and independently recommends solutions.

• Excellent organizational skills are required to prioritize responsibilities, thus completing work promptly.

• Outstanding ability to multi-task as required.

• Outstanding ability to make clear decisive decisions.

• Attention to detail and concern for impact is essential.

• Excellent project management skills.

Leadership Activities:

• Guides lower-level personnel.

• Regularly attends meetings and contributes to training sessions.

• Must be proactive to ensure proper follow-up and completion of projects.

• Must maintain a professional demeanor in sensitive situations.

• Assists other departments when necessary.

Communication Skills:

• Must work well with others.

• Effectively communicate with others by giving and receiving feedback.

• Communicates ideas and information clearly.

• Must have excellent communication and presentation skills to interface with internal and external HBR departments effectively.

Professional experience:

• High School Diploma required. Associate’s degree preferred.

• 2+ years of experience within the healthcare industry preferred.

• Experience with health/medical insurance and processing of claims.

• Solid written & verbal communication skills.

• Strong prioritizing & organizational skills.

• Excellent typing/data entry skills.

• Strong working knowledge of Microsoft Office suite as well as Adobe Acrobat.

Location and Workplace Flexibility

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

Base Salary Range

$19.00 - $24.00

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.