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

Z0VqUDJiLzBwbmw1Vk9IVWswQ2hFejZUSXc9PQ==
  • 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

The Abeel Firm PLLC

Family Law Paralegal Job at The Abeel Firm PLLC

Family Law Firm - Paralegal in Williamsville, NY (On Site) Help Redefine Family Law We're seekingan experienced family law paralegal or legal assistant who enjoys working systematically and documenting the process of how meaningful legal work is done. The ...

Global Edge Group

Material Handler - 1st shift Job at Global Edge Group

 ...Job Title: Material Handler - 1st shift Location: Springville, Utah Type of Role: Temp to Hire POSITION OVERVIEW: The...  ...documents, filing and achieving requirements. Follows all warehouse processes when performing work, while maintaining good housekeeping... 

PATLive

FRONT DESK RECEPTIONIST (REMOTE ) full-time/part-time Job at PATLive

 ...for financial information during the recruitment and hiring process. We are looking for a Friendly and professional Virtual Receptionist to join our team! This may be the perfect job for you if... You love talking to people over the phone Have experience... 

CarMax

Dealership Auto Technician Job at CarMax

4007 - New Kent - 16749 Weir Creek Blvd, West Point, Virginia, 23181 CarMax, the way your career should be! Temporary address: 16931 Eltham Rd. Barhamsville, VA 23181 CarMax is now hiring Automotive Technicians! Start loving what you do at CarMax Ensure... 

Sycamore Springs

Activity Therapist - Behavioral Health Job at Sycamore Springs

 ...opportunities. Qualifications and requirements: * Education: Bachelor's degree from an accredited institute in Recreational Therapy (CTRS), Music Therapy (MT-BC), Art Therapy (ATR, ATR-BC, ATR-P LPAT), or similar field required. * Experience: Previous experience in a...