Ops Analyst, DRG

Zelis; Saint Petersburg (FL); On-site; USD 54,000 - 68,400; Full time

Benefits offered by this job

401k with employer match

Flexible paid time off

Comprehensive health insurance

Job summary

Zelis is seeking a DRG Operations Analyst in Saint Petersburg, FL, to support the Expert Claims Review team. The role involves managing claim processes, client performance monitoring, and training new team members. Candidates should have a High School Diploma, with an Associate degree preferred, and 2+ years in healthcare or related fields. The position offers a competitive salary of $54,000 to $68,400 along with a comprehensive benefits package including 401k matching, paid time off, and health insurance.

Qualifications

• 2+ years of experience within the healthcare industry preferred.
• Experience in claim processing, medical billing, or a related field required.

Responsibilities

• Manage the screening and distribution processes for Expert Claim Review Claims.
• Assist with training and onboarding of new team members.
• Monitor new client claims post-implementation.

Skills

Communication skills

Organizational skills

Microsoft Office suite

Data entry skills

Education

High School Diploma

Associate degree

Tools

Adobe Acrobat

Job description

Zelis is modernizing the healthcare financial experience across payers, providers, and consumers, serving more than 750 payers and millions of providers. Our solutions focus on holistic optimization and measurable results for clients.

Position Overview

The DRG Operations Analyst provides daily operational support to the Expert Claims Review team, helping itemized bill review and DRG validation teams. Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and a deep understanding of client contractual parameters.

What You’ll Do

• Manage the screening and distribution processes for 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.
• Deploy resources for daily claims screening, distribution, and referral processes, including ECR and ECR‑EDI, DRG Validation and DRG Outlier pricing.
• Ensure all ECR claims are managed per client requirements.
• Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

What You’ll Bring

• High School Diploma required; Associate degree preferred.
• 2+ years of experience within the healthcare industry preferred.
• Solid written & verbal communication skills.
• Strong prioritizing & organizational skills.
• Excellent typing/data entry skills.
• Experience in claim processing, medical billing, or a related field.
• Strong working knowledge of Microsoft Office suite and Adobe Acrobat.

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

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; work location is based on role needs and leadership decisions.

Base Salary Range

$54,000.00 – $68,400.00.

Salary is part of a Total Rewards package that may also include discretionary bonus plans, commissions, or other incentives.

Zelis’ full‑time associates are eligible for a comprehensive benefits package: 401k with employer match, flexible paid time off, holidays, parental leave, life and disability insurance, and medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity

Zelis is an equal‑opportunity employer. All qualified applicants receive consideration regardless of race, color, religion, age, sex, national origin, disability status, genetics, veteran status, sexual orientation, gender identity or expression, or any other protected characteristic.

Accessibility Support

If you are a qualified individual with a disability or a disabled veteran who requires a reasonable accommodation during the application or interview process, please email [e-mail].

Disclaimer

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.