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Claim Edits Specialist Trainee

Ventra Health
Ventra health
2-4 years
preferred by company
Chennai, India
1 May 12, 2026
Job Description
Job Type: Full Time Education: M.Pharm/B.Pharm or M.Sc. Skills: Medical Coding, Medical Terminology, mRS and EQ-5D-5L., Narrative Writing, Research & Development, Technical Skill

Claim Edits Specialist Trainee

Job Category: Healthcare Revenue Cycle Management / Medical Billing
Department: Pre-Bill Operations / Claim Edits
Business Unit: Emergency & Hospital Medicine
Location: Perungudi, Chennai, India
Work Mode: Onsite
Employment Type: Full-Time
Shift: Night Shift
Experience Required: 2–4 Years Preferred (Freshers Not Eligible)

About the Role

A leading healthcare revenue cycle management organization is seeking a detail-oriented Claim Edits Specialist Trainee to join its pre-bill healthcare operations team in Chennai. This role is ideal for professionals with expertise in medical billing, claims editing, denial prevention, healthcare reimbursement workflows, payer rule validation, and claims resolution operations.

The selected candidate will be responsible for reviewing healthcare claims before submission, identifying billing discrepancies, applying corrective actions, and ensuring claim accuracy to reduce denials and payment delays.

This opportunity is ideal for professionals looking to grow their career in medical billing, healthcare claims management, denial prevention, revenue cycle operations, and payer compliance workflows.

Key Responsibilities

  • Review and analyze pre-submission healthcare claim edits to ensure billing accuracy.
  • Apply corrective actions based on payer-specific rules, client billing guidelines, and reimbursement standards.
  • Identify claim discrepancies that could lead to denials, rejections, or delayed reimbursements.
  • Collaborate with coding teams and charge entry teams to resolve claim edit issues.
  • Monitor recurring claim edit trends and recommend workflow improvements, rule updates, or automation enhancements.
  • Work with quality assurance and configuration teams to improve edit logic and billing process efficiency.
  • Assist in preparing reports, performance analysis, and root cause investigations for repeated claim edit failures.
  • Maintain departmental productivity, quality benchmarks, and service level agreement (SLA) expectations.
  • Support additional healthcare billing and operational improvement projects as assigned.

Required Qualifications

  • High School Diploma, GED, or equivalent qualification
  • 2–4 years of experience in medical billing, claims resolution, or healthcare reimbursement operations preferred
  • Experience in:
    • Claims review
    • Denial prevention
    • Medical billing workflows
    • Healthcare payer follow-up

Preferred Qualifications

Candidates with the following qualifications will have an advantage:

  • AAHAM certification
  • HFMA certification
  • Experience working with offshore healthcare operations teams
  • Exposure to advanced healthcare claim validation workflows

Core Skills & Expertise

  • Strong understanding of:
    • Payer-specific claim edits
    • Medical billing workflows
    • Healthcare reimbursement rules
    • Claim validation and denial prevention
  • Experience with healthcare billing and claim scrubber platforms such as:
    • Athena
    • Epic
    • eClinicalWorks (eCW)
  • Preferred knowledge of:
    • CPT coding
    • ICD-10 coding
    • HCPCS coding
  • Ability to quickly become proficient in billing software tools
  • Strong communication, analytical, and problem-solving skills
  • Proficiency in:
    • Microsoft Outlook
    • Microsoft Word
    • Microsoft Excel (including Pivot Tables)
    • Database software
  • Basic numerical, 10-key, and data entry proficiency
  • Ability to interpret billing regulations, payer rules, and healthcare compliance requirements
  • Ability to work efficiently in fast-paced collaborative environments