Job
Description
About Us At Zelis India, our mission is to enhance the healthcare financial experience by developing and implementing innovative solutions. We are dedicated to optimizing technology and processes for efficiency and effectiveness. Our collaborative work culture, leadership development initiatives, and global exposure opportunities create a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we strive to provide a holistic workplace experience. Our team at Zelis India maintains high standards of service delivery and contributes to our award-winning culture. Position Overview As a member of our team, you will be responsible for performing comprehensive inpatient DRG validation Quality Assurance reviews. Your role will involve assessing the accuracy of the DRG billed based on industry standard coding guidelines and clinical evidence provided by the provider. You will implement and conduct quality assurance programs to ensure accurate results for our clients. Additionally, you will manage assigned claims, adhere to client turnaround times and departmental Standard Operating Procedures, and serve as a Subject Matter Expert on DRG validation. Training new team members, identifying new DRG coding concepts, meeting productivity and quality standards, and recommending process improvements are key aspects of this role. Remaining current in national coding guidelines and ensuring adherence to Zelis standards regarding privacy are essential. Travel may be required to meet business needs. Required Qualifications To excel in this role, you should bring: - Preferred Registered Nurse licensure - Required Inpatient Coding Certification (e.g., CCS, CIC, RHIA, RHIT) - 5+ years of experience in reviewing and/or auditing ICD-10 CM, MS-DRG, and APR-DRG claims - Solid understanding of audit techniques, revenue opportunities identification, and financial negotiation with providers - Experience and working knowledge of Health Insurance, Medicare guidelines, and various healthcare programs - Strong understanding of hospital coding and billing rules - Clinical and critical thinking skills for evaluating appropriate coding - Strong organizational skills with attention to detail - Excellent communication skills, both verbal and written - Demonstrated thought leadership, motivation skills, and ability to research and resolve issues Work Environment The role involves a standard work week with the understanding that additional time/effort may be required based on client needs. The work environment is typical for a business setting with moderate noise levels. The ability to lift and move approximately thirty (30) pounds on a non-routine basis and sit for extended periods of time is necessary. Other Details As part of our team, you are expected to embody our culture and values. We offer industry-leading healthcare benefits, caregiving benefits, family forming & reproductive health benefits, mental well-being resources, savings & investments (401K), paid holidays, PTO, educational resources, giving programs, networking opportunities, and discounts on products and services. At Zelis, the well-being of our associates is essential. (Note: This job description is a summary and does not include all the specific job duties and requirements.),
