Ops Analyst, DRG

About the Role

The Operations Analyst, DRG 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.

What You'll 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.

Qualifications

• 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.

Pay

Base Salary Range: $54,000.00 - $68,400.00

Schedule

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-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.

Benefits

Zelis' full-time associates are eligible for a highly competitive benefits package, including 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.