Job Summary
Ensures claims accuracy by reviewing, validating, and correcting claim edits prior to submission to payers, thereby minimizing denials and rejections.

Essential Functions and Tasks
Analyze pre-submission claim edits and apply corrective actions per payer and client guidelines
Track claim edit trends and recommend rule updates or automation improvements
Work with coding and charge entry teams to resolve edit discrepancies.
Track claim edit trends and recommend rule updates or automation improvements.
Maintain quality and productivity standards as per departmental SLAs.
Collaborate with the QA and configuration teams to enhance edit logic efficiency.
Assist in preparing reports and root cause analyses for repeated edit failures.

Knowledge, Skills, and Abilities
Strong understanding of payer-specific edits and medical billing workflows
Experience with claim scrubber tools and billing systems like Athena, Epic, or eCW.
Knowledge of CPT, ICD-10, and HCPCS coding standards are preferred.




Become proficient in the use of billing software within 4 weeks and maintain proficiency
Ability to read, understand and apply state/federal laws, regulations, and policies
Ability to communicate with diverse personalities in a tactful, mature, and professional manner
Ability to remain flexible and work within a team-oriented and fast-paced environment
Basic use of a computer, telephone, internet, copier, fax, and scanner
Basic touch 10 key skills
Basic Math skills
Understand and comply with company policies and procedures
Solid oral, written, and interpersonal communication skills
Strong time management and organizational skills
Robust knowledge of Outlook, Word, Excel (pivot tables), and database software skills

Role: Claim Edits Specialist

Industry Type: US Healthcare

Employment Type: Full Time, Permanent

Education: Any Graduation

Regards,
Talent Acquisition Team
Ventra Health

📌 Claim Edits Specialist Chennai (India)
🏢 Ventra Health
📍 India