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Bill collector Jobs in Houston tx
Itemized Bill Review Facility Reviewer
ZelisRemote, TX, US- Promoted
- Promoted
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Bilingual Collector
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Itemized Bill Review Facility Reviewer
ZelisRemote, TX, US- Full-time
- Remote
Position Overview
At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and ensuring adherence to proper billing guidelines. They will work closely with Hospital Bill Review and Concept Development staff to efficiently identify and adhere to policies and procedures for claims processing. This position will also be responsible for developing new concepts, assisting with the quality assurance program, and being a resource for the entire organization regarding IBR claims. This is a production-based role with production metrics goals.
Key Responsibilities :
Conduct detailed review of hospital itemized bills for identification of billing and coding opportunities for all payor’s claims including restricted list
Review client payment policy documents : interpret and document the configurations to be applied to Zelis coding and clinical reviews
Translate client reimbursement policies into Zelis coding and clinical concepts
Provide direction to internal team based on understanding of client payment policies
Understand payor policies and their application to claims processing
Prepare and upload documentation clearly identifying findings
Accurately calculate / verify the value of review and documentation for claim processing
Monitor multiple reports to track client specific requirements, turnaround time and overall claims progression
Complete claims processing after the Clinical Bill Review and Audit analysis is completed.
Assist in appeals process as necessary
Collaborate between multiple areas within the department
Evaluate current Quality Assurance Process and implement recommended changes for efficiency & effectiveness
Monitor, research, and summarize changes as client reimbursement policy changes
Maintain individual productivity standard of 12 claims accepted per day with a savings acceptance threshold not to exceed TBC $1,000,000.00
Consistently meet or exceed personal quality standard of 85%
Lend expertise to implementation team as necessary
Act as a coding subject matter expert for department and clients
Remain current in all national coding guidelines including Official Coding Guidelines and AHA Coding Clinic and share with review team
Maintain awareness of and ensure adherence to Zelis standards regarding privacy
Qualifications :
CPC credential preferred
Working knowledge of health / medical insurance and handling of claims
General knowledge of provider claims / billing, with medical coding and billing experience
Knowledge of ICD-10 and CPT coding
Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers
Ability to manage and prioritize multiple tasks with strong attention to detail
Diligent research and organizational skills
Excellent verbal and written communication skills
Ability to work under pressure, meet deadlines, and prioritize tasks.
Proficient in Microsoft Office, more importantly Outlook, Excel, and Word
Excellent organizational and project management skills are required to prioritize responsibilities, thus completing work in a timely fashion.
Must have excellent communication and presentation skills to effectively interface with the entire staff, and external representatives from the business, financial, legal, and scientific communities
Location and Workplace Flexibility : We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.