Remote Quality Management System Jobs in Georgia

MEDHOST, a division of Harris; is seeking a Hospital Billing Representative who will support front end hospital billing and clean claim submission for insurance payers, including Medicare, Medicaid, Blue Cross, commercial payers, and other government entities.

This position is focused on front end hospital billing. The successful candidate will be responsible for reviewing, correcting, and submitting hospital claims through billing clearinghouses and payer systems. Candidates must have hands on experience with initial claim submission, claim edit resolution, clearinghouse workflows, and clean claim processing.

This is not an accounts receivable, collections, denial management, payment posting, patient balance follow up, or backend account follow up role. Candidates whose experience is primarily focused on AR aging, denied claims, unpaid claims, appeals, underpayment recovery, EOB review, payment posting, refunds, or patient collections will not be aligned with this position.

This remote role welcomes candidates anywhere in the US. Preference will be given to candidates who can work in CST timezone.

This position is focused on hospital FRONT billing and revenue cycle operations.Hospital billing experience including Medicare (DDE) is required for consideration. Candidates must have experience and a strong working knowledge of billing clearinghouses.

Wage:

$18-$28/hr

AI & Innovation Mindset

We are committed to leveraging emerging technologies to improve how we work, serve our customers, and drive business outcomes. The successful candidate will demonstrate curiosity and a willingness to actively adopt and leverage AI tools to improve workflows, solve problems, and increase efficiency. Candidates should be comfortable using AI enabled technologies, including copilots, chat based AI assistants, and automation tools, as part of their everyday work while maintaining appropriate judgment, security, and compliance standards.

What your impact will be:

• Coordinate daily front end hospital billing activities to ensure claims are reviewed, corrected, and submitted accurately to insurance payers.
• Submit initial hospital claims through billing clearinghouses and payer systems.
• Review and resolve front end claim edits before claims are released to payers.
• Correct billing issues related to diagnosis codes, procedure codes, charge codes, payer requirements, demographics, authorization details, or claim formatting.
• Work claim edit queues, rejected claim files, DDE claims, late charge claims, rebills, corrected claims, and shadow claims as assigned.
• Maintain a high clean claim rate by ensuring claims meet payer billing guidelines before submission.
• Use hospital billing software and third party clearinghouses to process and monitor claims at the submission stage.
• Maintain working knowledge of all software applications related to hospital billing and claims submission.
• Ensure facility rebills are worked and comments are logged on patient accounts within 7 business days.
• Communicate issues impairing the billing process to the Team Lead or Manager.
• Communicate with hospitals, internal teams, and payers when additional information is needed to correct and submit claims.
• Partner with other teams and departments to resolve billing, payer, clearinghouse, or claim submission issues.
• Submit billing and rebilling requests from customers and team members in a timely manner.
• Stay current with billing practices for private and government payers, including billing software applications and clearinghouse requirements.
• Assist in the training and education of new and existing employees.
• Maintain the effectiveness and implementation of the MEDHOST Quality Management System and meet applicable regulatory requirements.
• Accurately input and submit worked time by departmental deadlines.
• Maintain in depth knowledge of MEDHOST core products and third party clearinghouses.
• Maintain industry knowledge through self study and training.
• Recommend department and customer documentation.
• Provide training and training documentation in areas of expertise.
• Attend and participate in team and departmental meetings.
• Respond to emails, telephone calls, voicemails, Microsoft Teams messages, and correspondence from facilities in a timely manner.
• Adhere to all HIPAA Privacy and Security requirements.
• Perform duties in a positive manner that upholds company policies and procedures.
• Perform other duties as assigned.

Important clarification for applicants

• This is a front end hospital billing position focused on initial claim submission to insurance payers through billing clearinghouses. The role is responsible for reviewing claims before submission, resolving front end claim edits, correcting billing errors, and resubmitting clean claims for payer processing.
• Candidates must have experience and a strong working knowledge of billing clearinghouses. Candidates should be able to speak clearly about the clearinghouses they have used, the types of claim edits they have worked, and how they ensure claims are clean before they are submitted to payers.
• This role is not focused on backend accounts receivable, collections, denial management, appeals, underpayment recovery, payment posting, refunds, aging reports, EOB review, patient calls, or patient balance follow up.

What we are looking for:

• High School diploma or equivalent required.
• Minimum 1 year of front end hospital billing experience required.
• Minimum 1 year of experience submitting hospital claims through billing clearinghouses required.
• Minimum 1 year of experience utilizing hospital claims management or billing software required.
• Experience resolving front end claim edits before payer adjudication required.
• Experience working with hospital billing systems, claim edit queues, clearinghouse platforms, and payer submission workflows required.
• Working knowledge of institutional hospital claims, payer billing requirements, clean claim submission, rebills, corrected claims, late charges, DDE claims, and claim edit resolution.
• Ability to clearly explain prior experience with clearinghouses such as SSI, Availity, Waystar, Change Healthcare, TrueBridge, or Quadax.
• Ability to identify claim errors before submission and take appropriate corrective action.
• Ability to follow billing standards, department procedures, and payer guidelines independently.
• Strong attention to detail and ability to manage billing inventory accurately.
• Computer skills in Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.
• Customer service orientation with the ability to support internal teams, facilities, and customers professionally.
• High speed internet access with minimum 300 Mbps download speed and unlimited data.
• Smart phone for Multi Factor Authentication application.

What would make you stand out:

• MEDHOST or HMS knowledge.
• Experience maintaining a strong clean claim rate.
• Experience submitting Medicare, Medicaid, Blue Cross, commercial, and government payer claims.
• Experience working claim edit queues within a hospital billing environment.
• Experience with UB04, 837I, DDE, rebills, corrected claims, late charges, and clearinghouse edits.
• Knowledge of hospital billing, revenue cycle, and medical terminology.
• Ability to navigate healthcare information systems and clearinghouses.
• Ability to access protected health information in accordance with departmental assignments and guidelines.
• Skilled in making accurate arithmetic computations.
• Excellent verbal and written communication skills, good judgment, tact, initiative, and resourcefulness.
• Detail oriented, organized, and able to manage multiple priorities.
• Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives.
• Flexible with a can do attitude and ability to remain professional under high pressure situations.

What we can offer:

• 3 weeks' vacation and 5 personal days
• Comprehensive Medical, Dental, and Vision benefits starting from your first day of employment
• Employee stock ownership and RRSP/401k matching programs
• Lifestyle rewards
• Remote work and more!

About MEDHOST:

MEDHOST, founded in 1984 and headquartered in Franklin, Tennessee, is a leading provider of healthcare information technology solutions. Serving over 1,000 healthcare facilities nationwide, MEDHOST offers a comprehensive suite of products, including electronic health records (EHR), financial management systems, and patient engagement platforms. Their mission is to empower healthcare organizations to enhance patient care and improve business operations through innovative, user-friendly solutions. In January 2024, MEDHOST was acquired by N. Harris Computer Corporation, further strengthening its position in the healthcare IT industry.

About Harris:

Harris is a leading provider of mission critical software to the public sector in North America. As a wholly owned subsidiary of Constellation Software Inc. ("CSI", symbol CSU on the TSX), Harris has become the cornerstone for CSI's investment in utility, local government, school districts, public safety, and healthcare software verticals. Our success has been realized through investments in our proprietary software and market expertise. This focus, combined with acquiring businesses that build upon or complement our offerings, has helped drive our success. Harris will continue to growth through reinvestment - both in the people and products that we offer and making investments in acquiring new businesses.

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