Zelis is a healthcare information technology company and market-leading provider of end-to-end healthcare claims cost management and payment solutions.
Inc.5000 award winner: One of the fastest growing privately held companies in the US!
Ranked #1 by NJ Biz as the Fastest Growing Company in NJ!
Zelis Healthcare is a mid-cap healthcare technology growth company and market-leading provider of integrated healthcare cost management and payments solutions including network analytics, network access, network cost management, payment integrity and electronic payments to payers, healthcare providers and consumers in the medical, dental and workers' compensation markets nationwide. Zelis Healthcare is backed by Parthenon Capital Partners. www.zelis.com
oUR ZELIS PURPOSE
We founded Zelis to help control the rising cost of healthcare and make healthcare more affordable for all of us.
To efficiently handle the prepping of all incoming appeals. This role will act as the point of contact for the coding analyst teams as it relates to all incoming appeals.
Responsible for prepping and "policing" all incoming appeals assigned to personal queue; including but not limited to ensuring proper documentation as well as contact information is uploaded.
Adhering to client specific guidelines for special appeals handling.
Assign appeals to coding analysts in accordance with designated routing rules.
Review, resolve and complete all appeals assigned to queues
in which a review by a coding analyst is not required:
(ETF, Non-Accepted, Attachment Missing, projects as assigned).
Inputting requests to clients as needed for additional information;
following up on those requests in a timely manner and providing
resolution to the claim.
Aiding in preparation of a claim for adjustments as necessary.
Corresponding with Client Service Associates as needed in regard to
appeal related concerns: balance bills, escalated appeals, waiving
ETF guidelines, etc.
Handle and respond to appeals emails regarding appeal status and
appeal escalations; distributing appeals to Jr. Appeals Assistant for
Provide support to Junior Appeals Assistants as necessary.
Forwarding correspondence to appropriate department(s) as
Faxing out correspondence to providers as necessary.
Performs other related responsibilities as assigned
Maintain awareness of and ensure adherence to ZELIS standards regarding privacy.
Has developed an understanding of the appeal process and edit logic
Computer proficiency and technical aptitude with the ability to utilize CMS/Prizem, MS Office Applications, Adobe Application (PDF)
Works on assignments that are moderately complex in nature in which judgment and initiative are required to make recommendations or resolve problems, thorough knowledge of the company and departmental policies and procedures
High school diploma
1-2 years healthcare experience
Excellent written & verbal communication skills
Knowledge of MS Outlook, MS Word, MS Excel & Internet Explorer
Strong prioritizing & organizational skills for fast-paced department
Impeccable customer service & telephone skills
This is a full time position with an attractive hourly rate as well as comprehensive benefits plans to choose from.
OUR BIG 8 ZELIS VALUES
We take personal accountability
We look for a better way
We serve each other and are always there to help
We act level-less
We use humor
We develop serious expertise
We act with integrity
Thank you for your interest in the Zelis team!
Premier Healthcare Exchange, Inc.