Zelis · 22 hours ago
IBR Facility Reviewer
Boston, MA
Full-time
Onsite
Entry Level
$59K/yr - $75K/yr
1+ years expZelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. The Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and TPAs to ensure adherence to proper coding and billing guidelines while working closely with Expert Claim Review and Concept Development staff.
FinanceFinTechHealth Care
No H1B
Responsibilities
Conduct detailed review of hospital itemized bills for identification of billing and coding errors for all payor’s claims
Contribute process improvement and efficiency ideas to team leaders and in team meetings
Translate client reimbursement policies into Zelis coding and clinical concepts
Understand payor policies and their application to claims processing
Prepare and upload documentation clearly and precisely identifying findings
Accurately calculate/verify the value of review and documentation for claim processing
Monitor multiple reports to track client specific requirements, turnaround time and overall claims progression
Maintain individual average productivity standard of 10 processed claims per day
Consistently meet or exceed individual average quality standard of 85%
Ability to manage a variety of claim types with charges up to $500,000
Collaborate between multiple areas within the department as necessary
Follow standard procedures and suggest areas of improvement
Remain current in all national coding guidelines including Official Coding Guidelines and AHA Coding Clinic and share with review team
Maintain awareness of and ensure adherence to Zelis standards regarding privacy
Qualification
Required
Working knowledge of health/medical insurance and handling of claims
General knowledge of provider claims/billing, with medical coding and billing experience
Knowledge of ICD-10 and CPT coding
Ability to manage and prioritize multiple tasks
Attention to detail is essential
Accountable for day-to-day tasks
Excellent verbal and written communication skills
Proficient in Microsoft Office Suite
Preferred
CPC credential preferred
1 – 2 years of applicable healthcare experience 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
2026-01-15
2025-12-10
Company data provided by crunchbase