Manager, Itemized Bill Review

Position Overview

The Manager, Itemized Bill Review will collaborate closely with the Sr. Manager and Sr. Director of Clinical Coding serving as the Subject Matter Expert on coding within the Expert Claim Review Department. This will include creating and implementing program policies and procedures to ensure best practices. In addition, The Manager, IBR will research and stay abreast of inpatient and outpatient coding updates to ensure the team is capturing all potential saving opportunities. The Manager, IBR will investigate areas of coding opportunities within the current product and be responsible for recommending/documenting new opportunities, conducting training, and tracking performance impacts. This role will also be responsible for interpreting and assessing client payment policy data and assisting with provider disputes.

What you'll do:

• Serve as a coding subject matter expert for Expert Claim Review Department and clients to identify whitespace in current projects related to coding reviews and create strategy to tackle

• Implementation of new coding areas of savings to include: research, ROI analysis, SOPs, client support documents and training materials

• Participate in client facing meetings as necessary to assist in presenting coding results with supporting references

• Assist in dispute process and defense of denials as necessary

• Conduct ongoing team education regarding coding and/or billing errors including development of training materials

• Ability to push initiatives from inception to completion

• Must remain current in all national coding guidelines including Official Coding Guidelines, AHA Coding Clinic,, and AMA CPT Assistant

• Work closely with all Leaders of Expert Claim Review in departmental functions and special projects

• Evaluate program performance, prepare reports, and make recommendations for program development

• Must have an understanding of health plans and lines of business in addition to their interaction with policies and coding guidelines

• Management of a team is required

• Work closely with leadership to ensure Zelis culture

• Maintain awareness of and ensure adherence to Zelis standards regarding privacy

What you'll bring to Zelis:

• Coding certification required (e.g. Certified Professional Coder (CPC), Certified Coding Specialist (CCS))

• RN preferred, but not required

• 5+ years of relevant experience or equivalent combination of education & work within healthcare system

• 1+ year of management experience

• Itemized bill review and payment integrity experience including audit techniques, identification of revenue opportunities, and financial negotiation with providers

• Demonstrated track record of success in managing key process improvement initiatives

• Industry experience implementing complex programs

• Experience managing internal and external relationships

• Excellent written & verbal communication skills

• Outstanding ability to multiplex tasks as required

Base Salary Range

$59,000.00 - $75,050.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity  
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. 
 
We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. 

Accessibility Support 
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email [email protected]. 

  

Disclaimer 

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.