IBR Reviewer

ConfidentialHyderabad / Secunderabad, Telangana, India

5 days ago

Job description

About Us

Zelis is modernizing the healthcare financial experience in the United States (U.S.) across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

Why We Do What We Do

In the U.S., consumers, payers, and providers face significant challenges throughout the healthcare financial journey. Zelis helps streamline the process by offering solutions that improve transparency, efficiency, and communication among all parties involved. By addressing the obstacles that patients face in accessing care, navigating the intricacies of insurance claims, and the logistical challenges healthcare providers encounter with processing payments, Zelis aims to create a more seamless and effective healthcare financial system.

Zelis India plays a crucial role in this mission by supporting various initiatives that enhance the healthcare financial experience. The local team contributes to the development and implementation of innovative solutions, ensuring that technology and processes are optimized for efficiency and effectiveness. Beyond operational expertise, Zelis India cultivates a collaborative work culture, leadership development, and global exposure, creating a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we foster a holistic workplace experience. Additionally, the team plays a vital role in maintaining high standards of service delivery and contributes to Zelis' award-winning culture.

Position Overview

Skill Requirements :

CPC Certification – Preferred but not mandatory; candidates with the certification will be given an added advantage.
Experience in Denials and Clinical Investigators profiles will be suitable for this position.
Should have experience in Itemized Bill Reviewing
Strong understanding of medical insurance and claims processes.
Knowledge of medical billing and coding, payer policies, and reimbursement policies
Excellent Communication Skills

Targeted Companies : Optum, Omega, and Cotiviti

Additional Details

Shift Timing : Night shift (5 : 30 PM to 2 : 30 AM)

Work Environment : Clean room

Work Mode : 5 days from office

Open Positions : 4

Experience : 3-7 Years

Note : Please ensure that only strong and well-qualified profiles are submitted, as candidates will undergo an assessment at the final stage of the selection process.

Job Description

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

CPC credential preferred

1 – 2 years of applicable healthcare experience preferred

Graduate

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

Skills Required

cpt coding , Microsoft Office Suite

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Reviewer • Hyderabad / Secunderabad, Telangana, India