Corrected Claims Resolution Analyst, CPC
Company: Zelis
Location: Bedminster
Posted on: January 26, 2023
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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
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