Itemized Bill Reviewer

Position Overview

At Zelis, the Itemized Bill Review Facility Reviewer I is responsible for analyzing facility inpatient and outpatient claims for Health Plans and TPA’s to ensure adherence to proper coding and billing guidelines. They will work closely with Hospital Bill Review and Concept Development staff to efficiently identify billing errors and adhere to policies and procedures for claims processing. This is a production-based role with production and quality metric goals.

Key Responsibilities:

Conduct detailed review of hospital itemized bills for identification of billing and coding errors for all payor’s claims

Contribute process improvement and efficiency ideas to team leaders and in team meetings

Translate client reimbursement policies into Zelis coding and clinical concepts

Understand payor policies and their application to claims processing

Prepare and upload documentation clearly and precisely identifying findings