Operations Analyst, DRG

Position Overview

The Operations Analyst will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters.

Key responsibilities :

Managing the screening and distribution processes of Expert Claim Review Claims supporting the end-to-end workflow audit for Zelis Prepay and Post-pay Programs.

Assist with training and onboarding of new team members.

Monitor new client claims post-implementation to ensure high performance per client requirements.

Thoroughly understand all ECR clients, business processes, inventory management, file processes, and financial recovery tracking.

Accountable for the deployment of resources for the management of daily claims screening, distribution, and referral processes, including ECR and ECR-EDI, DRG Validation and DRG Outlier pricing.

Accountable for ensuring all ECR claims are managed per client requirements.

Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

Professional experience :

Associate or Bachelor's degree preferred.

2+ years of experience within the healthcare industry preferred.

Solid written & verbal communication skills.

Strong prioritizing & organizational skills.

Excellent typing / data entry skills.

Experience in claim processing, medical billing, or related a plus.

Strong working knowledge of Microsoft Office suite as well as Adobe Acrobat.

Location and Workplace Flexibility : We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.