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Itemized Bill Review Facility Reviewer

Company: Zelis Healthcare Corporation
Location: Bedminster
Posted on: September 17, 2021

Job Description:

The Itemized Bill Review Facility Reviewer will be responsible for analyzing facility inpatient and outpatient claims for Health Plans and ensuring adherence to proper billing guidelines. They will work closely with Hospital Bill Review, leadership and concept development staff to efficiently identify and adhere to policies and procedures for claims processing. This position will also be responsible for developing new concepts, assisting with the quality assurance program, and being a resource for the entire organization regarding IBR claims. This will be a production based role with production metrics adhered to.



Responsible for conducting detailed review of hospital itemized bills for identification of billing and coding opportunities for all payors claims including restricted list.

Review client payment policy documents. Interpret and document the configurations to be applied to Zelis coding and clinical reviews.

Translate client reimbursement policies into Zelis coding and clinical concepts.

Provide direction to internal team based on understanding of client payment policies.

Understand payor policies and their application to claims processing.

CIC Certified

CCS certified

Keywords: Zelis Healthcare Corporation, Newark , Itemized Bill Review Facility Reviewer, Other , Bedminster, New Jersey

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