Medical Biller / Claims Edit Job at Quest Group Executive Search and Staffing Solutions, Atlanta, GA

VnErRzAzWW1CYzJTM3FuTE5mMzNXaURQelE9PQ==
  • Quest Group Executive Search and Staffing Solutions
  • Atlanta, GA

Job Description

Quest Group is seeking a knowledgeable and detail-oriented Hospital Claims Edit/Billing Specialist to join our clients revenue cycle team. This role focuses on identifying and correcting claim errors, ensuring the accurate and timely submission of institutional claims, and working specifically with CMO payers . Candidates must have hands-on experience using Epic and Xactimed/FinThrive and be well-versed in managed Medicaid and other CMO plan billing rules.

This will be a 3-4 month contract assignment

Key Responsibilities:

  • Review and resolve claim edits within Epic work queues and FinThrive/Xactimed , ensuring clean claims are submitted promptly.
  • Correct and resubmit claims with issues related to coding, eligibility, charge posting, authorization, or other payer-specific requirements.
  • Specialize in processing claims to CMO payers (no medicaid)
  • Track, analyze, and follow up on rejected, denied, or underpaid claims.
  • Ensure compliance with payer regulations and hospital billing policies, particularly for Medicaid/CMO claims.
  • Maintain accurate and detailed documentation of all claim activity and resolutions.
  • Communicate with internal departments (coding, patient access, case management) to resolve billing discrepancies.
  • Identify payer trends, frequent denials, or edit patterns and report findings to leadership for process improvement.

Required Qualifications:

  • High school diploma or equivalent required; Associate’s degree or medical billing certification preferred.
  • Minimum 2–3 years of hospital billing experience , including claim edits and billing to CMO payers (e.g., Medicaid Managed Care Organizations).
  • Proficiency with Epic (billing modules, claim edit work queues) and Xactimed/FinThrive is required .
  • Strong understanding of UB-04 billing, CPT/HCPCS, ICD-10, modifiers, and payer billing protocols.
  • Familiarity with CMS, Medicaid, and commercial payer reimbursement policies.
  • Exceptional attention to detail, organizational, and follow-up skills.
  • Ability to meet deadlines, manage work queues efficiently, and work both independently and collaboratively.

Job Tags

Contract work,

Similar Jobs

HonorVet Technologies

Registered Nurse - Correctional Job at HonorVet Technologies

 ...Job Description HonorVet Technologies is seeking a travel nurse Correctional for a travel nursing job in Shelby, Montana. Job Description & Requirements ~ Specialty: Correctional ~ Discipline: RN ~ Start Date: 02/16/2026~ Duration: 10 weeks ~36 hours... 

Schneider

CDL-A - Dedicated Flatbed truck driver - VT Industries (Bel Air) Job at Schneider

 ...weekly Home time: Weekly Experience: 3 months or greater CDL experience Overview ~ Haul countertops with curtainside...  ...Minimum 3 months of Class A driving experience. Need CDL training? Explore our company-paid CDL training programs or call us at... 

Doc Cafe

Neurology Physician Assistant - Competitive Salary Job at Doc Cafe

 ...DocCafe has an immediate opening for the following position: Physician Assistant - Neurology in Toledo, Ohio.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.----------------Register now to apply for this job... 

Forrest Solutions

Office Assistant Job at Forrest Solutions

 ...professional, friendly, and cooperative attitude at all times Greet and assist customers promptly, ensuring a clean, productive, and welcoming...  ..., and multifunction devices (MFDs) Proficiency with Microsoft Office products Strong written and verbal communication skills... 

Lincoln Property Company

Risk Manager Job at Lincoln Property Company

 ...The Risk Manager supports executive leadership by developing and implementing insurance solutions for the organization. Successful solutions are based on a deep understanding of the business model of the organization, design of risk strategies that align with the business...