What are the responsibilities and job description for the Analyst Provider Resolution Dispute position at Zelis Payments, part of Zelis?
Job Overview
We are seeking a detail-oriented Provider Dispute Resolution Analyst to join our dynamic team. The primary responsibility of this role is to effectively address provider disputes related to Fee Negotiation, Network, Multi-Service, and Bill Review & Audit claims, including the potential for claims renegotiation. Successful candidates will possess exceptional customer service skills, characterized by strong verbal and written communication abilities. This position will focus on key performance metrics such as average resolution time for disputes, average retention of savings, frequency of dispute processing, and precise documentation to ensure optimal service delivery to both clients and providers. The ideal candidate will demonstrate strong problem-solving skills to tactfully and accurately resolve issues.
Key Responsibilities
We offer substantial opportunities for professional development within our organization, enabling employees to refine their skills and advance their careers through exposure to various departments and functions.
Company Culture And Values
Our company fosters a collaborative work environment where teamwork is paramount. We encourage open communication and mutual support among employees, all contributing to a culture centered on client and provider satisfaction.
Employment Type: Full-Time
We are seeking a detail-oriented Provider Dispute Resolution Analyst to join our dynamic team. The primary responsibility of this role is to effectively address provider disputes related to Fee Negotiation, Network, Multi-Service, and Bill Review & Audit claims, including the potential for claims renegotiation. Successful candidates will possess exceptional customer service skills, characterized by strong verbal and written communication abilities. This position will focus on key performance metrics such as average resolution time for disputes, average retention of savings, frequency of dispute processing, and precise documentation to ensure optimal service delivery to both clients and providers. The ideal candidate will demonstrate strong problem-solving skills to tactfully and accurately resolve issues.
Key Responsibilities
- Investigate and resolve provider and client billing inquiries, renegotiating claims as needed to secure savings while achieving departmental KPI targets.
- Maintain comprehensive tracking of all essential information related to assigned tasks.
- Collaborate closely with internal teams, including Client Services, Network and Vendor Management, Out of Network Services, and Bill Review & Audit, to efficiently coordinate and resolve issues.
- Provide support to colleagues in addressing complex claims or escalated provider concerns.
- Engage with clients directly to offer updates and communicate resolved issues.
- Uphold compliance with HIPAA and Zelis standards regarding privacy.
- Offer coverage and assistance to the Customer Care Team when necessary.
- Execute additional related responsibilities as assigned.
- Outstanding verbal and written communication capabilities.
- Strong analytical and problem-solving skills.
- Ability to manage multiple tasks and prioritize effectively.
- Familiarity with HIPAA and privacy regulations.
- Experience in billing or claims processing is advantageous.
- High school diploma or equivalent is required.
- Previous experience in a similar role is preferred.
- Strong attention to detail and analytical aptitude.
- Ability to work independently while also being an effective team player.
We offer substantial opportunities for professional development within our organization, enabling employees to refine their skills and advance their careers through exposure to various departments and functions.
Company Culture And Values
Our company fosters a collaborative work environment where teamwork is paramount. We encourage open communication and mutual support among employees, all contributing to a culture centered on client and provider satisfaction.
Employment Type: Full-Time