Claim Edits Specialist

Overview

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

Responsibilities

• 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.

Qualifications

• High School Diploma or GED.
• At least two to four (2-4) years of medical billing and claims resolution experience preferred
• AAHAM and/or HFMA certification preferred
• Experience with offshore engagement and collaboration desired