Operations Analyst, DRG

Position Overview

The Operations Analyst will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams.  Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters.

• Managing the screening and distribution processes of Expert Claim Review Claims supporting the end-to-end workflow audit for Zelis Prepay and Post-pay Programs.

• Assist with training and onboarding of new team members.

• Monitor new client claims post-implementation to ensure high performance per client requirements.

• Thoroughly understand all ECR clients, business processes, inventory management, file processes, and financial recovery tracking.

• Accountable for the deployment of resources for the management of daily claims screening, distribution, and referral processes, including ECR and ECR-EDI, DRG Validation and DRG Outlier pricing.

• Accountable for ensuring all ECR claims are managed per client requirements.

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

What You’ll Bring to Zelis 

• High School Diploma required. Associate degree preferred.

• 2+ years of experience within the healthcare industry preferred.

• Solid written & verbal communication skills.

• Strong prioritizing & organizational skills.

• Excellent typing/data entry skills.

• Experience in claim processing, medical billing, or related a plus.

• Strong working knowledge of Microsoft Office suite as well as Adobe Acrobat.

Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

Commitment to Diversity, Equity, Inclusion, and Belonging 
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

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 encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.  

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].  

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