DRG Operations Analyst-1

Position Overview

The Operations Analyst will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters.

Key responsibilities:

Managing the screening and distribution processes of Expert Claim Review Claims supporting the end-to-end workflow audit for Zelis Prepay and Post-pay Programs.

Assist with training and onboarding of new team members.

Monitor new client claims post-implementation to ensure high performance per client requirements.

Thoroughly understand all ECR clients, business processes, inventory management, file processes, and financial recovery tracking.

Accountable for the deployment of resources for the management of daily claims screening, distribution, and referral processes,...