Claims Editing Support Associate

Premier Healthcare Exchange, Inc. Bedminster , NJ 07921

Posted 2 months ago

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!

COMPANY BACKGROUND/CULTURE

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.

Position Overview

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.

KEY RESPONSIBILITIES

  • 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

  • attachment.

  • Provide support to Junior Appeals Assistants as necessary.

  • Forwarding correspondence to appropriate department(s) as

  • necessary.

  • 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

professional experience/qualifications

  • 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

COMPENSATION:

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

  • We celebrate

Thank you for your interest in the Zelis team!


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Claims Editing Support Associate

Premier Healthcare Exchange, Inc.