Claim Edits Specialist

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

Come Join Our Team!

• As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards
  
  
  

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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.
  
  
  

Education And Experience Requirements

• 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
  
  
  

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 collaborative 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
• Strong oral, written, and interpersonal communication skills
• Strong time management and organizational skills
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills
  
  
  

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons .
• This position is also eligible for a discretionary incentiv e bon us in accordance with company policies .
  
  
  

Ventra Health

Equal Employment Opportunity (Applicable only in the US)

Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.

Recruitment Agencies

Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.

Solicitation of Payment

Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates

Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.

To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at [email protected] to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/.

Statement of Accessibility

Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.