Operations Analyst

Zelis • St. Louis, MO

7d • $19 - $24 • Hybrid

About The Position

The Operations Analyst will provide daily operational support to the Itemized Bill Review team, including the itemized bill review, clinical chart review, and document retrieval teams. Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters. At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.

Requirements

• Demonstrates a solid understanding of screening and audit techniques for identifying revenue opportunities.
• Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue.
• Computer proficiency and technical aptitude with the ability to utilize CMS and MS Office Suite.
• Development and adherence to department SOP’s.
• Thorough knowledge of company and departmental policies and procedures.
• Act as subject matter experts to various departments
• Maintain personal and department production and financial goals.
• Requires minimal daily supervision.
• Ability to make decisions based on established guidelines and gained knowledge of HBR departments and client standards.
• Regularly reviews goals and objectives with the supervisor.
• Ability to follow detailed instructions on new assignments.
• Accountable to day-to-day tasks.
• Must be professional and respect the confidentiality of administrative matters and files.
• Ability to manage and prioritize multiple tasks.
• Ability to work under pressure and meet deadlines.
• Makes logical suggestions for likely causes of problems and independently recommends solutions.
• Excellent organizational skills are required to prioritize responsibilities, thus completing work promptly.
• Outstanding ability to multi-task as required.
• Outstanding ability to make clear decisive decisions.
• Attention to detail and concern for impact is essential.
• Excellent project management skills.
• Guides lower-level personnel.
• Regularly attends meetings and contributes to training sessions.
• Must be proactive to ensure proper follow-up and completion of projects.
• Must maintain a professional demeanor in sensitive situations.
• Assists other departments when necessary.
• Must work well with others.
• Effectively communicate with others by giving and receiving feedback.
• Communicates ideas and information clearly.
• Must have excellent communication and presentation skills to interface with internal and external HBR departments effectively.
• High School Diploma required.
• 2+ years of experience within the healthcare industry preferred.
• Experience with health/medical insurance and processing of claims.
• 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’s degree preferred.

Responsibilities

• Manage the screening and distribution processes of Itemized Bill Review claims and support 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 IBR 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 IBR and IBR-EDI, DRG validation, IBR Distribution, and support for Out-of-Network report management.
• Responsible for the set up and processing of dual acceptance claims, as well as the creation and accuracy of client facing documentation.
• Accountable for ensuring all IBR claims are managed per client requirements.
• Maintain awareness of and ensure adherence to Zelis standards regarding privacy.
• Assist other Zelis staff members as needed, and as requested.

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