Physician Services Edit Specialist II

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!

JOB SUMMARY

The SPEC, PHYS SVC EDIT is responsible for the processing and monitoring of claim edits. The SPEC, PHYS SVC EDIT ensures claims are correct by analyzing TES edits, claim form requirements and rejections.

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
• Meets or Exceeds department Productivity standard 20 invoices/hour depending on client worked
• Meets or Exceeds Quality Assurance standard of 95% or higher
• Communicate with clients via email
• Train new hires
• Other duties may be assigned

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.

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.

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

EDUCATION / EXPERIENCE

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

• High School diploma or equivalency required
• 1-4yrs IDX/EPIC/Next Gen experience
• 1-4yrs Collection or Medical insurance billing experience
• Moderate Excel knowledge
• Ability to work independently and multi-task various assignments
• Good written and oral communication skills
• Good 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