IBR Facility Reviewer

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. The IBR Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims to ensure adherence to proper coding and billing guidelines, while working closely with various teams to identify billing errors and improve processes.

Responsibilities

• 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

• 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
• CPC credential preferred
• 1 – 2 years of applicable healthcare experience preferred

Benefits

• 401k plan with employer match
• Flexible paid time off
• Holidays
• Parental leaves
• Life and disability insurance
• Health benefits including medical, dental, vision, and prescription drug coverage

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