Certified Corrected Claim Resolution Analyst Details

Certified Corrected Claim Resolution Analyst

Zelis - Remote

Employment Type : Full-Time

The Certified Corrected Claim Resolution Analyst will be responsible for reviewing claims and/or medical records for appropriate billing as well as processing/responding to any incoming corrected claims and/or inquiries related to determinations with providers.

Summary of Responsibilities

• Researching manuals/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/guidelines in responding to corrected claims
• 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
• Performs other related responsibilities as assigned.
• Maintain awareness of and ensure adherence to Zelis standards regarding privacy

Competencies

• 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

Summary of Qualifications

• 5+ 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 Preferred

Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claims. Zelis delivers integrated network analytics, network solutions, payment integrity, electronic payments and claims communications for payers, healthcare providers and consumers in the medical, dental and workers' compensation markets nationwide. Zelis is backed by Parthenon Capital Partners and Bain Capital.


“We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.”