Medical Bill Navigator
Zelis NA

Position Overview:

The Medical Bill Navigator will be a concierge to members in understanding how their benefits were applied to a medical bill he/she has received. This advocacy includes but not limited to providing recommendations to the member on how to resolve conflicting benefit application to negotiating amounts related to patient liability and/or amounts he/she is being balance billed. The Medical Bill Navigator will assist Management in developing/enhancing operational workflows while also being strategic in how the product in itself may compliment the overall Zelis vision.

Key Responsibilities:

• Analyze Medical Claims submitted by members to evaluate benefit application that may lead to next steps of member contact or provider negotiations.
  
• Contact Members related to a claim submitted for review to discuss items such as but not limited to documents needed, clarification on services, and/or information related to payment that could result from negotiations.
  
• Contact medical providers to negotiate greatest discount/savings on claims submitted to Zelis.
  
• Contact medical providers to ensure balances are written off that resulted from a successful negotiation.
  
• Potentially contact the member's Health Plan to help member understand and potentially resolve benefit questions/issues.
  
• Monitor In-Process Claims Report in order to manage assigned volume in an efficient and timely manner.
  
• Assist Members on any related dispute/issue on claims that resulted from a Zelis Negotiations.
  
• Communicate with Members on claim inquires as requested per provider.
  
• Assist in training and continuing education of new team members.
  
• Analyze financial tools such as Medicare to understand egregious of claim.
  
• Work along other departments such as Editing and BR&A to secure larger discounts through clinical tools provided.
  
• Analyze quality of work to ensure no errors being made such as acceptances, non-acceptances, and offer submittals.
  
• Assist management in providing recommendations for process and technical improvements.
  
• Maintain awareness of and ensure adherence to Zelis standards regarding privacy.
  

Professional Experience/Qualifications:

• 4+ years of Medical Claims experience
  
• Experience in Medical Claims Negotiations
  
• Excellent verbal communication skills
  
• Exceptional organizational skills
  
• Proficient knowledge of Microsoft Outlook, Word, and Excel
  
• Detailed-oriented and able to work in a fast-paced environment.
  

Location and Workplace Flexibility: We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

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.

Commitment to Diversity, Equity,Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment 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.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com

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