Physician Services Edit Specialist III - Remote

JOB SUMMARY 

The SPEC, PHYS SVC EDIT is responsible for the processing and monitoring of claim edits. 

The SPEC, PHYS SVC EDIT analyzes claims for process improvements to reduce edits.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Resolve daily clearinghouse edits
• Resolve daily host system claim form edits
• Resolve edits within EPIC Edit WQ’s, Retro, etc
• Resolve Statement/Return Mail address edits
• Print Medical Records/Documentation
• Contact various insurance carriers to resolve edits
• Responsible for reviewing accounts, verifying eligibility, updating registration, rebill activities and leaving detailed account notes
• Exceed department Productivity standard 20 invoices/hour depending on client worked
• Exceed Quality Assurance standard of 95% or higher
• Communicate with clients via email, conference calls and onsite meetings
• Train new hires
• Perform system testing for upgrades (Super user)
• Analyze edits and denials and provides recommendations and solutions to reduce inventory
• Other duties may be assigned

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Great problem solving and analytical skills
• Excellent communication skills
• Exceptional organizational skills and priority planning
• Ability to perform essential job functions with a high degree of independence, flexibility, and creative problem-solving techniques
• Attentive listening skills 
• Great attention to detail
• Ability to Multi-task

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• High School diploma or equivalency required 
• 4+yrs IDX/EPIC/Next Gen experience
• 4+yrs Collection or Medical insurance billing experience
• Microsoft Office Knowledge including Outlook, Word, Excel, Visio and PowerPoint
• Ability to work independently and multi-task various assignments 
• Excellent written and oral communication skills 
• Great problems solving and analytical skills 

PHYSICAL DEMANDS 

The physical demands described here are representative of …