Operations Analyst

Skip to main contentWe use cookies to make the safest and most effective website possible. DeclineAccept CookiesZelis CareersSign InOperations Analyst page is loadedOperations AnalystApplylocationsUS FL RemoteUS TX PlanoUS MA BostonUS MO St. Louis (Corp)US GA AtlantaView All 6 Locationstime typeFull timeposted onPosted 26 Days Agojob requisition idJR111237At Zelis, we Get Stuff Done. So, let’s get to it!   A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.  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 OverviewThe Operations Analyst will provide daily operational support to the Itemized Bill Review team, including the itemized bill review, clinical chart review, and document retrieval teams. Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters.Key responsibilities:Manage the screening and distribution processes of Itemized Bill Review claims and support the end-to-end workflow audit for Zelis Prepay and Post-pay Programs.Assist with training and onboarding of new team members.Monitor new client claims post-implementation to ensure high performance per client requirements.Thoroughly understand all IBR clients, business processes, inventory management, file processes, and financial recovery tracking.Accountable for the deployment of resources for the management of daily claims screening, distribution, and referral processes, including IBR and IBR-EDI, DRG validation, IBR Distribution, and support for Out-of-Network report management.Responsible for the set up and processing of dual acceptance claims, as well as the creation and accuracy of client facing documentation.Accountable for ensuring all IBR claims are managed per client requirements.Maintain awareness of and ensure adherence to Zelis standards regarding privacy.Assist other Zelis staff members as needed, and as requested.JOB REQUIREMENTS:Technical Skills / Knowledge:Demonstrates a solid understanding of screening and audit techniques for identifying revenue opportunities.Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue.Computer proficiency and technical aptitude with the ability to utilize CMS and MS Office Suite.Development and adherence to department SOP’s.Thorough knowledge of company and departmental policies and procedures.Act as subject matter experts to various departmentsIndependence/ Accountability:Maintain personal and department production and financial goals.Requires minimal daily supervision.Ability to make decisions based on established guidelines and gained knowledge of HBR departments and...