DRG Ops Analyst

Zelis • Plano, TX

4d • Hybrid

About The Position

At Zelis, we Get Stuff Done. So, let’s get to it! Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. The DRG 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.

Requirements

• High School Diploma required.
• Solid written & verbal communication skills.
• Strong prioritizing & organizational skills.
• Excellent typing/data entry skills.
• Strong working knowledge of Microsoft Office suite as well as Adobe Acrobat.

Nice To Haves

• Associate degree preferred.
• 2+ years of experience within the healthcare industry preferred.
• Experience in claim processing, medical billing, or related a plus.

Responsibilities

• 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.

Benefits

• 401k plan with employer match
• flexible paid time off
• holidays
• parental leaves
• life and disability insurance
• health benefits including medical, dental, vision, and prescription drug coverage

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED