Manager, Itemized Bill Review
Zelis
full-time
Posted on:
Location Type: Hybrid
Location: St. Petersburg • Florida • Massachusetts • United States
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Salary
💰 $59,000 - $75,050 per year
About the role
- 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
Requirements
- 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
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
coding reviewsROI analysisSOPstraining materialscoding guidelinesaudit techniquesfinancial negotiationprocess improvementitemized bill reviewpayment integrity
Soft Skills
client supportteam educationinitiative managementcommunication skillstask multiplexingrelationship managementleadershippresentation skillsreport preparationrecommendation making
Certifications
Certified Professional Coder (CPC)Certified Coding Specialist (CCS)