Zelis · 1 day ago
Itemized Bill and Clinical Chart Dispute Reviewer
Atlanta, GA
Full-time
Hybrid
Mid, Senior Level
$71K/yr - $95K/yr
5+ years expZelis is modernizing the healthcare financial experience across various stakeholders. The Itemized Bill and Clinical Chart Dispute Reviewer role involves resolving facility and provider disputes related to itemized bill review and clinical claim reviews, ensuring compliance with coding and billing guidelines.
FinanceFinTechHealth Care
No H1B
Responsibilities
Review provider disputes for Itemized Bill Review (IBR) and Clinical Chart Review (CCR) and submit explanation of dispute rationale back to providers based on dispute findings within the designated timeframe to ensure client turnaround times are met
Accountable for daily management of claim dispute volume, adhering to client turnaround time, and department Standard Operating Procedures
Serve as subject matter expert for the Expert Claim Review Team on day-to day activities including troubleshooting and review for data accuracy
Serve as a subject matter expert for content and bill reviews and provide support where needed for inquiries and research requests
Create and present education to Expert Claim Review Teams and other departments dispute findings
Research and analysis of content for bill review
Use of strong coding and industry knowledge to create and maintain bill review content, including but not limited CCR Review Guidelines and Templates, Itemized Bill Review Coding guidelines and Dispute Rationales
Perform regulatory research from multiple sources to keep abreast of compliance enhancements and additional bill review opportunities
Support for client facing teams as needed relating to client inquiries related to provider disputes
Utilize the most up-to-date approved Zelis medical coding sources for bill review maintenance
Communicate and partner with CMO and members of Expert Claim Review Product and Operations teams regarding important issues and trends
Ensure adherence to quality assurance guidelines
Monitor, research, and summarize trends, coding practices, and regulatory changes
Actively contribute new ideas and support ad hoc projects, including time-sensitive requests
Ensure adherence to quality assurance guidelines
Maintain awareness of and ensure adherence to ZELIS standards regarding privacy
Qualification
Required
Current, active Outpatient Coding Certification required (such as CPC, CCS, or equivalent credentialing)
Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers
Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
Understanding of hospital coding and billing rules
Clinical skills to evaluate appropriate Medical Record Coding
Experience performing regulatory research from multiple sources, formulating an opinion, and presenting findings in an organized, concise manner
Background and/or understanding of the healthcare industry
Knowledge of National Medicare and Medicaid regulations
Knowledge of payer reimbursement policies
Creative problem-solving skills, leveraging insights and input from other parts of an organization
Consistently demonstrate ability to act and react swiftly to continuous challenges and changes
Excellent analytical skills with data and analytics related solutions
Excellent communication skills
Strong organization and project/process management skills
Strong initiative, self-directed and self-motivation
Good negotiation, problem solving, planning and decision-making skills
Ability to manage projects simultaneously and achieve goals
Excellent follow through, attention to detail, and time management skills
Preferred
5+ years reviewing and/or auditing itemized bill review and clinical chart review claims preferred
Registered Nurse licensure preferred
Bachelor's Degree Preferred in business, healthcare, or technology preferred
Benefits
401k plan with employer match
Flexible paid time off
Holidays
Parental leaves
Life and disability insurance
Health benefits including medical, dental, vision, and prescription drug coverage
Company
Zelis
Zelis is modernizing the healthcare financial experience for all.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$20.15MKey Investors
Mubadala
2024-12-04Private Equity
2020-01-05Private Equity· $20.15M
2019-01-01Private Equity
Leadership Team
Amanda Eisel
Chief Executive Officer
Brian Gladden
Chief Financial Officer
Recent News
2025-12-10
2025-12-04
FF News | Fintech Finance
2025-11-13
Company data provided by crunchbase