Ops Analyst, DRG

At Zelis we Get Stuff Done. So lets get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience 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.

At Zelis AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo accelerate innovation and amplify their impact. This is a place for builders with a growth mindset who act with agility embrace change and use modern technology to shape smarter solutions exceptional experiences and the future of our industry for our clients customers and our culture.

A Little About You

You bring a unique blend of personality and professional expertise to your work inspiring others with your passion and dedication. Your career is a testament to your diverse experiences community involvement and the valuable lessons youve learned along the way. You are more than just your resume; you are a reflection of your achievements the knowledge youve gained and the personal interests that shape who you are.

Position Overview

What youll do:

• 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.

What youll bring:

• High School Diploma required. Associate 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.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

Zelis is headquartered in the U.S. with multiple locations across the country and in Hyderabad India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership -office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

Base Salary Range

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors including experience education qualifications as well as job-related and industry-related knowledge and skills etc. Base pay is just one part of our Total Rewards package which may also include discretionary bonus plans commissions or other incentives depending on the role.

Zelis full-time associates are eligible for a highly competitive benefits package as well which demonstrates our commitment to our employees health well-being and financial protection. The US-based benefits include a 401k plan with employer match flexible paid time off holidays parental leaves life and disability insurance and health benefits including medical dental vision and prescription drug coverage.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified 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 welcome applicants from all backgrounds and encourage you to apply even if you dont meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support
We 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 .

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities duties and skills from time to time.