Medical Bill Navigator

At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The Medical Bill Navigator, Health Bill Assist will be responsible for delivering high-touch, concierge-level support to members navigating the complexities of medical billing and benefit application. Serving as a dedicated advocate for members in an inbound and outbound call center setting, this role focuses on identifying and resolving various claim processing and provider billing issues. Additionally, the Medical Bill Navigator also supports efforts to negotiate reduced provider account balances, helping members achieve more favorable financial outcomes. What you will do:

• Analyze medical claims submitted by members along with their Explanation of Benefits (EOB) to verify accuracy of claim processing and provider billing
• Manage and resolve member cases involving claim processing issues, provider billing inaccuracies, and balance billing concerns
• Assist members with a variety of claim-related inquiries
• Provide member education on claim processing and benefit application with the ability to explain medical billing and insurance concepts in a clear and empathetic manner
• Communicate with medical providers to perform claim research and address billing discrepancies when identified
• Engage in provider negotiations to reduce outstanding member balances
• Collaborate with members' health plans to research claim issues and ensure accurate claim processing resolutions
• Provide ongoing case follow-up to ensure timely and successful resolution
• Assist with Intake Specialists handling of member portal submissions
• Assist in training initiatives to enhance team knowledge and efficiency
• Adhere to Key Performance Indicators (KPI's) set forth by management in relation to member support
• Maintain high standards of accuracy and quality on all member case work and communications
• Adhere to Zelis and regulatory privacy standards to guard protected health information
• Must be available to travel as required to meet business needs

What you'll bring to Zelis:

• Bachelor's Degree
• 5+ years of medical claims & member benefit application experience
• Strong analytical and problem-solving skills to investigate and resolve complex billing and claims issues
• Exceptional organizational skills
• Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.
• Excels working in both an independent capacity and team environment
• Proficient knowledge of Microsoft Outlook, Word, Excel

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. 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 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. Base Salary Range $54,000.00 - $72,000.00 At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified 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 welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. 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 [email protected]. Disclaimer We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time. Apply tot his job Apply To this Job