Summary of Responsibilities
- Audits and tests demographic and/or fee schedule imports based on work queue assignment.
- Process network and directly contracted demographic conversions.
- Maintain fee schedule crosswalk and network specific base tables used in the demographic conversion process.
- Researches and resolves issues regarding provider data, fee schedules and facility rates originating from various departments and conversion audits.
- Provides on-going database cleanup through various reports, research and phone calls.
- Other duties may be assigned as needed.
Competencies
- Knowledge of MS Office and related applications.
- Demonstrates the ability to learn and utilize Zelis proprietary systems.
- Manage data received in various formats from various sources.
- Proficient knowledge of MS Access and Excel.
- Proficient knowledge of relational databases.
- Familiar with claims repricing logic and provider matching.
Summary of Qualifications
- Bachelor’s Degree with two (2) or three (3) years related experience and/or training or equivalent combination of education and experience
- Detailed oriented with strong written and oral communication.
- Ability to learn and utilize Zelis proprietary systems
- Proficient with MS Office (Word, Excel and Access), Outlook and Internet, FTP sites and downloading of files.
work environment
- Possesses detail-orientation as well as strong written and oral communication skills.
- Demonstrates self-motivation and the ability to work independently and as a team.
- Demonstrates ability to handle, balance and prioritize workload from various service units and individuals in a fast-paced environment.
- Ability to deal with problems involving a few concrete variables in standardized situations.
As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
Zelis provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type 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.
SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.
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