Claims Support Specialist
Company: Zelis Healthcare, LLC
Location: Boston
Posted on: September 20, 2023
Job Description:
Position OverviewThe Claims Support Specialist will provide
daily operational support to the Expert Claims Review (ECR) team.
They will work closely with Document Retrieval, Concept
Development, DRG and Itemized Bill Review teams to ensure adherence
to company policies and procedures for claims processing to support
internal inventory management.Key Responsibilities
- Claim data entry in multiple platforms
- Group claim data including demographics, diagnosis and
procedure codes utilizing the encoder
- Repricing of claims and claim management
- Verify and process contracted client DRG revisions and
repricing
- Monitor queues and screen claims based on ECR prioritization
and client requirements
- Participate in new client implementations
- Perform overflow tasks to support Itemized Bill Review
product
- Collaborate between multiple areas within the department as
necessary
- Assist with monitoring and analyzing product performance
reports
- Maintain awareness of and ensure adherence to Zelis standards
regarding privacySkills, Knowledge, and Experience
- Experience with health/medical insurance and handling of claims
required
- General knowledge of provider claims/billing experience
preferred
- General knowledge medical coding experience preferred,
including ICD-10 and CPT coding
- Strong organization skills with attention to detail
- Outstanding verbal and written communication skills
- Ability to work proactively to ensure proper follow-up and
completion of projects#LI-RZ1As a leading payments company in
healthcare, we guide, price, explain, and pay for care on behalf of
insurers and their members. We're Zelis in our pursuit to align the
interests of payers, providers, and consumers to deliver a better
financial experience and more affordable, transparent care for all.
We partner with more than 700 payers, including the top-5 national
health plans, BCBS insurers, regional health plans, TPAs and
self-insured employers, over 4 million providers, and 100 million
members, enabling the healthcare industry to pay for care, with
care. Zelis brings adaptive technology, a deeply ingrained service
culture, and a comprehensive navigation through adjudication and
payment platform to manage the complete payment process.Commitment
to Diversity, Equity,Inclusion, and BelongingAt Zelis, we champion
diversity, equity, inclusion, and belonging in all aspects of our
operations. We embrace the power of diversity and create an
environment where people can bring their authentic and best selves
to work. We know that a sense of belonging is key not only to your
success at Zelis, but also to your ability to bring your best each
day.Equal Employment Opportunity Zelis is proud to be an equal
opportunity employer. All 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
encourage members of traditionally underrepresented communities to
apply, even if you do not believe you 100% fit the qualifications
of the position, including women, LGBTQIA people, people of color,
and people with disabilities. Accessibility SupportWe 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
TalentAcquisition@zelis.com SCAM ALERT: There is an active
nationwide employment scam which is now using Zelis to garner
personal information or financial scams. This site is secure, and
any applications made here are with our legitimate partner. If
you're contacted by a Zelis Recruiter, please ensure whomever is
contacting you truly represents Zelis Healthcare. We will never
asked for the exchange of any money or credit card details during
the recruitment process. Please be aware of any suspicious email
activity from people who could be pretending to be recruiters or
senior professionals at Zelis.
Keywords: Zelis Healthcare, LLC, Boston , Claims Support Specialist, Other , Boston, Massachusetts
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