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.

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