Itemized Bill Reviewer

Position Overview

At Zelis, the Itemized Bill Review Facility Reviewer I is responsible for analyzing facility inpatient and outpatient claims for Health Plans and TPA’s to ensure adherence to proper coding and billing guidelines. They will work closely with Hospital Bill Review and Concept Development staff to efficiently identify billing errors and adhere to policies and procedures for claims processing. This is a production-based role with production and quality metric goals.

Key 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, Knowledge, and Experience :