Job details
Job type full-time
Full job description
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 claimsZelis delivers integrated network analytics, network solutions, payment integrity, electronic payments and claims communications for payers, healthcare providers and consumers in the medical, dental and workers` compensation markets nationwideZelis is backed by parthenon capital partners and bain capital.
Zelis requires proof of covid-19 vaccination upon hire.
Position overview:
The manager, operations drives management, development & process improvement within the hospital bill review departmentThis will include getting close to processes and understanding the detailed workflows and routing rulesRecommendations to leadership regarding improvements and innovation will be requiredEffective team management is a mustFocus will be on pipeline management and ensuring workflows are followed in addition to executing on efficiencies, improvements and establishing metrics to track changesManaging a small team and ensuring work priorities are followed may be requiredAdditionally, this role will use analytics to evaluate current and additional/ future revenue optimization opportunities and coordinate with the management team to follow the roadmap to continue to drive value.
Key responsibilities:
Monitor current processes and claims pipeline and ensure claims are routed and worked as intended.
Ensure client tats and specific processing guidelines are followed.
Meets and exceeds client service level agreement (sla) requirements.
Focus on key operational tasks inclusive of evaluation of current process and recommended improvements.
Assess, track and report on any incentive programs associated with staff and alignment with goals on a monthly and annual basis.
Submission/tracking of it requests associated with process enhancement for the hospital bill review department including user acceptance testing for enhancements.
Develops direct reports through on-going feedback, coaching and mentoring as well as bi-annual associate evaluations.
Implementation of new clinical bill review enhancements to include: research, roi analysis, sop’s, client support documents, training materials (i.e., specialty drug management, report enhancements).
Collaboration between multiple areas within the organization will be necessary.
Management of a small team required, prioritize work within the team and ensuring coverage on all tasks on a daily, weekly, or monthly basis.
Ability to push initiatives from inception to completion.
Develop key product growth objectives through improved savings retention initiatives (performance improvement).
Continuous assessment of product results at individual client level and make recommendations/changes to enhance outcomes.
Understand provider billing nuances and service type trends to drive new ideas of approaches, processes or technology to support the ongoing success of the product.
Deliver monthly reporting metrics tied to the performance of the product and the associates that support the product.
Partner with the project management office & business analyst team as applicable.
Identify, assess, develop and implement potential third party partner relationships to improve the overall product by increasing hit rates and/or savings rates year-over-year.
Evaluate current quality assurance process and implement recommended changes for efficiency & effectiveness.
Use analytics to evaluate current concepts, determine how to improve our smart screening process to focus on providers or concepts with highest hit rates
Evaluate current workflow and identify routing issues or areas where hbr can expand our current footprint
Assist with hbr $2m revenue optimization projects, helping to drive analytics of new concepts, exclusion removals, client threshold adjustments, and capture this incremental revenue
Evaluate standard operating procedures for department and update and maintain accordingly
Work closely with vp of hospital bill review & other managers in departmental functions and special projects.
Research & implement third party tools/software, training and methodologies to ensure auditing success.
Job requirements:
Technical skills / knowledge:
Demonstrates solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers.
Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue.
Knowledgeable of medical terminology, claims coding and other billing patterns and practices of providers.
Computer proficiency and technical aptitude with the ability to utilize internal systems, encoderpro, other audit software and tools, ms office suite.
Thorough knowledge of company and departmental policies and procedures.
Ability to analyze data and monitor and report trends necessary.
Independence/ accountability:
Requires minimal daily supervision.
Regularly reviews goals and objectives with team.
Achieve personal production goals and savings quotas.
Ability to follow detailed instructions on new assignments.
Accountable to day to day tasks.
Must have professional manner and respect the confidentiality of administrative matters and files.
Ability to manage and prioritize multiple tasks.
Ability to work under pressure and meet deadlines.
Problem solving:
Makes logical suggestions as to likely causes of problems and independently recommends solutions.
Excellent organizational skills are required to prioritize responsibilities, thus completing work in a timely fashion.
Outstanding ability to multiplex tasks as required.
Excellent project management skills.
Attention to detail and concern for impact is essential.
Leadership activities:
Provides guidance to lower-level personnel.
Regularly attends meetings and leads 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 as necessary.
Communication skills:
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 effectively interface with the entire staff, and external representatives from the business, financial, legal and scientific communities.
Business-related travel:
Travel requirements to (primarily) domestic destinations should not exceed 40%.
Professional experience:
Bachelors degree required.
5+ years of relevant experience or equivalent combination of education & work within healthcare payers.
Experience and working knowledge of health insurance, medicare guidelines and various healthcare programs.
Experience managing a team necessary.
Demonstrated track record of success in managing key process improvement initiatives.
Industry experience implementing complex programs.
Experience managing internal and external relationships.
Excellent verbal & written communication skills.
Physical demands:
Walking, standing and sitting.
Long periods of computer usage.
Handling – seizing, holding, grasping and fingering of objects, tools and controls.
Reaching.
Vision – close vision.
Hearing- ability to receive detailed information through oral and telephonic communication.
Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
Ability to sit for extended periods of time.
Work environment:
A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.
A standard business environment exists with moderate noise levels.
Disclaimer the above statements are intended to describe the general nature and level of work being performed by people assigned to this classificationThey are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classifiedAll personnel may be required to perform duties outside of their normal responsibilities, duties, and skills required of personnel so classifiedAll personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.
“we are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.”
