Role Description 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. - Coordinating daily front end hospital billing activities to ensure claims are reviewed, corrected, and submitted accurately to insurance payers. - Submitting initial hospital claims through billing clearinghouses and payer systems. - Reviewing and resolving front end claim edits before claims are released to payers. - Correcting billing issues related to diagnosis codes, procedure codes, charge codes, payer requirements, demographics, authorization details, or claim formatting. - Working claim edit queues, rejected claim files, DDE claims, late charge claims, rebills, corrected claims, and shadow claims as assigned. - Maintaining a high clean claim rate by ensuring claims meet payer billing guidelines before submission. - Using hospital billing software and third party clearinghouses to process and monitor claims at the submission stage. - Maintaining working knowledge of all software applications related to hospital billing and claims submission. - Ensuring facility rebills are worked and comments are logged on patient accounts within 7 business days. - Communicating issues impairing the billing process to the Team Lead or Manager. - Communicating with hospitals, internal teams, and payers when additional information is needed to correct and submit claims. - Partnering with other teams and departments to resolve billing, payer, clearinghouse, or claim submission issues. - Submitting billing and rebilling requests from customers and team members in a timely manner. - Staying current with billing practices for private and government payers, including billing software applications and clearinghouse requirements. - Assisting in the training and education of new and existing employees. - Maintaining the effectiveness and implementation of the MEDHOST Quality Management System and meeting applicable regulatory requirements. - Accurately inputting and submitting worked time by departmental deadlines. - Maintaining in depth knowledge of MEDHOST core products and third party clearinghouses. - Maintaining industry knowledge through self study and training. - Recommending department and customer documentation. - Providing training and training documentation in areas of expertise. - Attending and participating in team and departmental meetings. - Responding to emails, telephone calls, voicemails, Microsoft Teams messages, and correspondence from facilities in a timely manner. - Adhering to all HIPAA Privacy and Security requirements. - Performing duties in a positive manner that upholds company policies and procedures. - Performing other duties as assigned. Qualifications - 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. Requirements - 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. Benefits - 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!

Role Description Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities. The Long-Term Care (LTC) Medical Coding Policy SME serves as a subject matter expert supporting Wisconsin Medicaid Long-Term Care programs through medical coding analysis, policy implementation, systems collaboration, and project participation. This role is responsible for: - Reviewing and evaluating CPT, HCPCS, and ICD-10 coding updates. - Supporting MMIS-related initiatives. - Researching complex policy and coding questions. - Partnering with internal and external stakeholders to ensure coding guidance, system configuration, and reimbursement policies remain accurate and compliant. The ideal candidate combines healthcare coding expertise with strong critical thinking, project management, communication, and documentation skills. Qualifications - Experience working with CPT, HCPCS Level II, ICD-10, medical coding, reimbursement policy, claims processing, provider enrollment, healthcare operations, or Medicaid programs. - Preferred certifications include Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT). - Strong critical thinking, analytical, and problem-solving skills. - Project management experience, including planning, coordinating, and driving cross-functional initiatives. - Experience leading meetings, coordinating stakeholders, drafting agendas, documenting meeting minutes, and tracking project deliverables. - Excellent written and verbal communication skills. - Proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, Teams, and SharePoint. Requirements - Opportunity to support Wisconsin Medicaid Long-Term Care programs. - Collaboration with state agencies, business partners, MMIS teams, provider enrollment teams, and healthcare policy stakeholders. - Participation in cross-functional projects involving coding policy, systems implementation, provider operations, and reimbursement methodologies. - Independent remote work environment requiring strong organization, prioritization, project management, and stakeholder engagement skills. - Professional growth through involvement in healthcare policy development, Medicaid operations, medical coding initiatives, and enterprise-wide projects. Benefits - Generous, flexible vacation policy. - 401(k) employer match. - Comprehensive health benefits. - Educational assistance. - Leadership and technical development academies.

• Audit coded claims against underlying clinical documentation to identify unsupported codes, documentation gaps, and recurring errors. • Code claims directly, spending part of your time on direct coding work. • Flag documentation patterns, with enough specificity to support clinician facing compliance feedback. • Respond to payer audits as they come in, handling documentation requests and audit responses alongside our Head of RCM. • Support MIPS/QPP eligibility review for our provider portfolio. • Escalate unclear or exception cases rather than guessing. • Maintain accurate records of audit findings and coding activity using our tracking tools.

• Perform medical claim reviews for the Special Investigations Unit (SIU) • Ensure compliance with coding practices through comprehensive record reviews • Conduct comprehensive medical record audits • Provide detailed written summaries of medical record review findings • Assist with investigative research related to coding questions and policies