Operations Analyst

Position Overview

The Operations Analyst will provide daily operational support to the Expert Claims 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 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 set up 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.
• 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 ECR departments effectively.
  
  

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.
• 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: We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

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 TalentAcquisition@zelis.com

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.