Corrected Claims Resolution Analyst, CPC

Company: Zelis
Location: Bedminster
Posted on: January 26, 2023

Job Description:

The Certified Corrected Claim Resolution Analyst will be responsible for reviewing claims and/or medical records for appropriate billing as well as processing, escalating /routing and responding to any incoming corrected claims and/or inquiries related to determinations with providers. The Certified Corrected Claim Resolution Analyst will work closely with supervisor and Manager as it relates to corrected claim. SUMMARY OF RESPONSIBILITIES+ Researching manuals and guidelines (including but not limited to AMA, CMS, and ZELIS Clinical Manual) once an appeal is received by ZELIS+ Utilizing the most up to date documentation and guidelines in responding to corrected claims+ Monitor turnaround to ensure timely processing of claims and research status of outstanding claims and expedite the processing of priority claims per client's TAT by escalating to the management+ Customizing and/or creating response letters in a professional manner+ Handling appeals and/or telephone/email inquiries related to determination of corrected claims+ Mentor and/or assist with Junior/ Coding Analysts+ Work closely with internal staff/departments and respond to claim related inquiries+ Performs other related responsibilities as assigned+ Communicate and keep Supervisor and /or Manager abreast of any edits trending and issues+ Ensure clients/business owners are serviced in utmost professional manner as well as building and maintaining exceptional relationships with internal staff/department+ Maintain awareness of and ensure adherence to ZELIS standards regarding privacyCOMPETENCIES+ Excellent customer service skills+ Exceptional professionally written communication skills+ Diligent research and organizational skills+ Ability to multi-task and detailed-oriented required+ Knowledge of Microsoft Word & Excel a must+ Has proficiency in Medical coding and use of various research materials used to render savings decisions on behalf of clients+ Flexibility and adaptability to changes in business priorities and processes+ SUMMARY OF QUALIFICATIONS+ 3+ years healthcare and medical claims processing experience within a provider/facility's office or Payer+ CPC or equivalent credentialing, maintained in good status, required.+ Associates Degree PreferredWORK ENVIRONMENT+ Possesses detail-orientation as well as strong written and oral communication skills.+ Demonstrates self-motivation and the ability to work independently and as a team.+ Demonstrates ability to handle, balance and prioritize workload from various service units and individuals in a fast-paced environment.+ Ability to deal with problems involving a few concrete variables in standardized situations.#LI-EL1 #LI-RemoteAs a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We're Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.As the leading healthcare payments company, we price, pay and explain care for payers, providers, and healthcare consumers. Zelis was founded on a belief there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment because more affordable and transparent care is good for all of us. We partner with over 700 payers, 1.5 million providers, and millions of members -- enabling the healthcare industry to pay for care, with care.Zelis brings adaptive technology, a deeply ingrained service culture, and an integrated pre-payment through payments platform to manage the complete payment process.

Keywords: Zelis, Newark , Corrected Claims Resolution Analyst, CPC, Professions , Bedminster, New Jersey