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

R3hzb2R4Qk1lVmtXS3lZQzNXVlRibUhwRmc9PQ==
  • 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

MOGEL

Warehouse Operations Crew Member Job at MOGEL

 ...| Looking to join a mission-driven team supporting the distribution of learning solutions that impact students nationwide? An EdTech company is seeking an Operations Crew Member to join its warehouse team in Rock Rapids, Iowa. This is a hands-on opportunity for... 

Mayo Clinic

Research Fellow-Department of Radiology at Mayo Clinic Florida Job at Mayo Clinic

 ...Why Mayo Clinic Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation... 

EōS Fitness

General Manager Job at EōS Fitness

 ...skills. Strong attention to detail while producing accurate and high quality work. Available to work weekdays, weekends, holidays, mornings, early-mornings, afternoons, evenings and late-night shifts. Must be extremely organized. Able to work independently,... 

Veridian Tech Solutions, Inc.

Senior SAP Consultant Job at Veridian Tech Solutions, Inc.

 ...Role: Principal SAP GTS Consultant Locations: Atlanta, GA Type of Hiring: Fulltime Job Description: Bachelors degree or foreign equivalent required from an accredited institution. Will also consider three years of progressive experience in the specialty... 

Lettire Construction Corp.

Driver Job at Lettire Construction Corp.

 ...ground up builder in the tri-state area , are seeking a skilled Driver and Construction Inventory Coordinator to join our team ....  ...inventory management of tools from projects, loading/unloading and delivery/transport of materials. This role is crucial for ensuring...