Position Overview: The Zelis Network Services Coordinator – Provider Support position requires adaptable knowledge including all elements of the Zelis Proprietary Networks and Zelis Clients. A process and service expert whose responsibilities include client communication, support and resolution, as the individual in this role will serve as a liaison to ensure provider needs are met in a prompt and efficient manner. The ability to efficiently orga...
Position Overview: The Certified Edit Dispute Resolution Analyst will be responsible for researching and auditing medical records for complex, diverse, multi-specialty provider claims to identify and determine appropriately coded billed services when compared to the Zelis Claim Edits Product. The Certified Edit Dispute Resolution Analyst demonstrates an understanding of Zelis edits as an individual contributor for processing, escalating, routing,...
Position Overview: The DRG Validation Nurse Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific...
