Remote

Manager, Itemized Bill Review

Zelis Healthcare, LLC
401(k), remote work
United States, Massachusetts
Apr 07, 2025
At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience for all by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts-driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The Manager, Itemized Bill Review will collaborate closely with the Sr. Manager and Sr. Director of Clinical Coding serving as the Subject Matter Expert on coding within the Expert Claim Review Department. This will include creating and implementing program policies and procedures to ensure best practices. In addition, The Manager, IBR will research and stay abreast of inpatient and outpatient coding updates to ensure the team is capturing all potential saving opportunities. The Manager, IBR will investigate areas of coding opportunities within the current product and be responsible for recommending/documenting new opportunities, conducting training, and tracking performance impacts. This role will also be responsible for interpreting and assessing client payment policy data and assisting with provider disputes. What you'll do: Serve as a coding subject matter expert for Expert Claim Review Department and clients to identify whitespace in current projects related to coding reviews and create strategy to tackle Implementation of new coding areas of savings to include research, ROI analysis, SOPs, client support documents and training materials Participate in client facing meetings as necessary to assist in presenting coding results with supporting references Assist in dispute process and defense of denials as necessary Conduct ongoing team education regarding coding and/or billing errors including development of training materials Ability to push initiatives from inception to completion Must remain current in all national coding guidelines including Official Coding Guidelines, AHA Coding Clinic, and AMA CPT Assistant Work closely with all Leaders of Expert Claim Review in departmental functions and special projects Evaluate program performance, prepare reports, and make recommendations for program development Must have an understanding of health plans and lines of business in addition to their interaction with policies and coding guidelines Management of a team is required Work closely with leadership to ensure Zelis culture Maintain awareness of and ensure adherence to Zelis standards regarding privacy What you'll bring to Zelis: Coding certification required (e.g. Certified Professional Coder (CPC), Certified Coding Specialist (CCS)) RN preferred, but not required 5+ years of relevant experience or equivalent combination of education & work within healthcare system 1+ year of management experience Itemized bill review and payment integrity experience including audit techniques, identification of revenue opportunities, and financial negotiation with providers Demonstrated track record of success in managing key process improvement initiatives Industry experiences implementing complex programs Experience managing internal and external relationships Excellent written & verbal communication skills Outstanding ability to multiplex tasks as required 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 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. Our Values and Culture We are always thinking about life beyond the laptop and how we can drive positive change for our clients, our associates, and our communities. Our IMPACT Value Behaviors are how we elevate that thinking and turn it into action: Drive Innovation Embrace a Growth Mindset Put People First Act With Agility Champion Collaboration Build Trust We look at the big picture when it comes to our associates and our culture. We work to effectively build a thriving, exciting experience for our associates. We leverage these values to continuously evolve an award-winning culture that has a longevity greater than the novelty of a ping pong table in the break room. Our idea of a great workplace is where we can show up as our authentic selves-which is the best way to bring together extraordinary talented people who feel empowered to make a positive IMPACT. A Lot of Respect This is a collaborative organization where everyone is on your team. Each person-from the newest intern to the CEO-is in their position because they are an expert, and they view you with the same lens. No matter who you are, where you sit in the organization, or the span of your tenure, everyone at Zelis is treated with respect. We respect your time (so much so that we aren't asking you to write a cover letter). We make sure you have time to focus by offering Meeting-Free Wednesdays as well as time for you with Zelis Cares Fridays early dismissal. We respect and prioritize work-life balance. With flexible PTO, a hybrid/remote work environment, and a culture that encourages disconnecting after hours, we ensure you have the time and space to manage life's surprises and fully engage outside of work. Working "9 to 5" isn't just a hit song; we respect business hours and promote wellness offerings to keep you at your best, both on and off the clock. We respect diverse opinions. There are always seats at the table, and we're eager to add more chairs. We continue to build our Diversity, Equity, and Inclusion initiatives including training, guest speakers, associate-led Business Resource Groups, in-office DEI events, and more. We respect that everyone has different needs. Zelis has built and continues to add to our benefits offerings by including medical, dental, 401k, fertility and family building, education assistance, pet insurance, menopause and midlife care, and more. We respect YOU. As an Equal Opportunity Employer, we believe that everyone's voice has a place in the chorus. We encourage members of traditionally underrepresented communities to apply. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com. Disclaimer We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.