Certified Dispute Resolution Analyst

Zelis

Remote
  • Job Type: Full-Time
  • Function: Business Intelligence
  • Post Date: 04/28/2021
  • Website: zelis.com
  • Company Address: 2 Crossroads Drive, Bedminster, NJ, 07921

About Zelis

Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claims.

Job Description

Description & Requirements

Position Overview

The Certified Dispute Resolution Analyst will be responsible for reviewing claims and/or medical records for appropriate billing as well as processing/responding to any incoming disputes and/or inquiries related to determinations with providers.

 

Summary of Responsibilities

  • Researching manuals/guidelines (including but not limited to AMA, CMS, and Zelis Clinical Manual) once an appeal is received by Zelis
  • Utilizing the most up to date documentation/guidelines in responding to disputes
  • Customizing and/or creating response letters in a professional manner
  • Handling appeals and/or telephone/email inquiries related to determination of dispute
  • Mentor and/or assist with Junior/ Coding Analysts
  • Performs other related responsibilities as assigned.
  • Maintain awareness of and ensure adherence to Zelis standards regarding privacy
Competencies
  • Excellent customer service skills
  • Exceptional professionally written communication skills
  • Diligent research and organizational skills
  • Ability to multi-task and detailed-oriented required
  • Knowledge of Microsoft Word & Excel a must
  • Has proficiency in Medical coding and use of various research materials used to render savings decisions on behalf of clients
Summary of Qualifications
  • 5+ years healthcare and medical claims processing experience within a provider/facility’s office or Payer
  • CPC or equivalent credentialing, maintained in good status, required.
  • Associates Degree Preferred

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Disclaimer: Local Candidates Only
This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.