Manager, Itemized Bill Review

Position Overview

What youll do:

• Serve as a coding subject matter expert for Expert Claim Review Department and clients to identify whitespace in current projects related to coding reviews and create strategy to tackle

• Implementation of new coding areas of savings to include: research ROI analysis SOPs client support documents and training materials

• Participate in client facing meetings as necessary to assist in presenting coding results with supporting references

• Assist in dispute process and defense of denials as necessary

• Conduct ongoing team education regarding coding and/or billing errors including development of training materials

• Ability to push initiatives from inception to completion

• Must remain current in all national coding guidelines including Official Coding Guidelines AHA Coding Clinic and AMA CPT Assistant

• Work closely with all Leaders of Expert Claim Review in departmental functions and special projects

• Evaluate program performance prepare reports and make recommendations for program development

• Must have an understanding of health plans and lines of business in addition to their interaction with policies and coding guidelines

• Management of a team is required

• Work closely with leadership to ensure Zelis culture

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

What youll bring to Zelis:

• Coding certification required (e.g. Certified Professional Coder (CPC) Certified Coding Specialist (CCS))

• RN preferred but not required

• 5 years of relevant experience or equivalent combination of education & work within healthcare system

• 1 year of management experience

• Itemized bill review and payment integrity experience including audit techniques identification of revenue opportunities and financial negotiation with providers

• Demonstrated track record of success in managing key process improvement initiatives

• Industry experience implementing complex programs

• Experience managing internal and external relationships

• Excellent written & verbal communication skills

• Outstanding ability to multiplex tasks as required

Base Salary Range

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 dont 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 .

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.