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 those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.              

• Ability to work additional hours as needed
• Ability to work in a fast-paced environment

WORK ENVIRONMENT 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Business office environment

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $14.50 - $21.80 per hour. Compensation depends on location, qualifications, and experience. 
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.