Bill Reviewer Jobs (NOW HIRING)

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.

The Director, Itemized Bill Review (IBR) is responsible for the strategic leadership, operational performance, innovation, and growth of the Itemized Bill Review solution across the Expert Claims Review business. This role serves as the enterprise leader for IBR, accountable for product performance, operational execution, quality outcomes, client value realization, and future-state solution development.

• Strategic Leadership & Business Ownership

  Own the strategic direction, growth, and performance of the Itemized Bill Review solution across all clients and lines of business. Accountable for achieving savings, revenue, and productivity targets for the solution. Develop and execute multi-year business plans that support organizational growth, client value, operational scalability, and product innovation. Establish, monitor, and report on key performance indicators (KPIs) and operational, financial, quality, and client performance metrics, utilizing data-driven insights to identify opportunities, mitigate risks, and drive achievement of strategic and operational goals. Partner with executive leadership to identify new savings opportunities, growth initiatives, and competitive differentiation strategies. Translate coding, reimbursement, regulatory, and market trends into strategic business recommendations and future-state product capabilities.

• Innovation, AI & Automation Leadership

  Lead the identification, prioritization, and implementation of AI, machine learning, and automation opportunities across the IBR solution. Partner with Product, Technology, and Analytics teams to modernize IBR workflows and improve scalability, productivity, coding accuracy, and savings capture. Drive the development of technology-enabled review methodologies that reduce manual effort while maintaining quality and compliance standards. Establish a multi-year innovation roadmap for the IBR solution aligned with enterprise automation and digital transformation objectives.

• Operational Leadership & Global Team Management

  Lead and develop a globally distributed team across the United States and India, ensuring operational consistency, workforce planning, talent development, and scalability. Establish performance management frameworks, quality standards, and operational governance processes that support business growth. Drive continuous improvement initiatives that improve productivity, savings outcomes, quality performance, and turnaround times.

• Product, Technology & Solution Evolution

  Serve as the executive business owner and strategic stakeholder for IBR product enhancements, automation initiatives, technology investments, and platform modernization efforts. Partner with Product leadership to prioritize investments that improve operational efficiency, savings performance, client outcomes, and scalability.

• Client, Market & Growth Leadership

  Serve as executive sponsor and subject matter expert for strategic client engagements, implementations, escalations, and growth initiatives. Partner with Sales, Client Management, and Implementation teams to support client retention, expansion opportunities, and new business growth. Represent the IBR solution during executive client presentations, strategic business reviews, and industry discussions.

• Data, Analytics & Business Insights

  Leverage operational, coding, and financial data to identify trends, risks, and opportunities. Drive data-informed decision-making through savings analytics, quality metrics, operational reporting and client trend analysis.

• Compliance, Quality & Governance

  Maintain enterprise oversight of coding compliance, quality standards, audit methodologies, and reimbursement integrity. Ensure adherence to HIPAA, Official Coding Guidelines, AHA Coding Clinic, CPT Assistant guidance, and organizational policies.

• Current coding certification required (CPC, CCS, RHIT, RHIA, or equivalent).
• 10-12+ years of experience in coding review, itemized bill review, reimbursement integrity, payment integrity, or related healthcare functions.
• 5+ years of progressive leadership experience leading managers, supervisors, or large operational teams.
• Demonstrated experience leading operational transformation, automation, AI-enabled initiatives, or technology modernization efforts.
• Deep understanding of payer reimbursement methodologies, coding guidelines, healthcare claims, and payment integrity programs.
• Preferred experience leading globally distributed teams, supporting automation, artificial intelligence, machine learning, or advanced analytics initiatives.
• Preferred experience influencing product strategy, technology investments, and operational transformation programs; supporting large-scale healthcare payer or payment integrity organizations.
• Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies. While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

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.

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 TalentAcquisition@zelis.com.

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.