Director, Itemized Bill Review

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.

At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.

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

What You'll Do:

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.

• Evaluate emerging technologies, coding intelligence tools, and reimbursement analytics capabilities to improve operational performance and client outcomes.

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.

• Foster a culture of innovation, accountability, collaboration, and continuous learning across global teams.

• Ensure effective resource allocation and organizational structures to support strategic priorities and future growth.

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.

• Drive the identification, development, and implementation of new coding concepts, reimbursement methodologies, and savings opportunities.

• Provide strategic oversight for automation, machine learning, advanced analytics, and workflow transformation initiatives.

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.

• Identify emerging market opportunities and trends that strengthen the IBR solution and drive measurable client value.

• 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.

• Partner with Analytics and BI teams to develop enhanced reporting capabilities and actionable business insights.

• Ensure effective measurement and reporting of business outcomes, operational performance, and value realization.

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.

• Establish governance frameworks that support consistency, accountability, risk mitigation, and operational excellence.

• Ensure quality assurance programs support scalable, repeatable, and high-confidence review outcomes.

What You'll Bring:

• 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.

• Experience supporting automation, artificial intelligence, machine learning, or advanced analytics initiatives.

• Experience influencing product strategy, technology investments, and operational transformation programs.

• Experience 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.

Location and Workplace Flexibility

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. 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.

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 TalentAcquisition@zelis.com.

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.