Medical Billing & Denials Specialist

SUMMARY:

The Medical Billing & Denials Specialist ensures that all patient/insurance information, charges, billings and follow-up on patient accounts is accurate, complete, and timely. Prepares and submits claims to various insurance companies through appropriate channels. Responsible to retrieve status information from payer websites and update patient account information as needed to ensure denials are worked thoroughly for timely reimbursement. Responsible for reviewing accounts which have been denied or underpaid by third party payers; the specialist will work across departments to gather the appropriate documentation and information for a clear and concise appeal. Understand medical billing/denials guidelines, and medical terminology.

RESPONSIBILITIES:

• Medical Billing & Claims Management: Submit and track insurance claims, resolve denials and billing edits, process remittances and adjustments, and ensure timely and accurate account resolution in line with payer requirements.

• Appeals & Reimbursement Review: Conduct detailed reviews of denied or underpaid claims, prepare appeal letters, gather supporting documentation, and collaborate across departments to ensure successful claim outcomes.

• Customer Service & Communication: Respond to patient inquiries, verify insurance eligibility and authorizations, and maintain thorough documentation while ensuring clear communication across Revenue Cycle teams.

• Compliance & Operational Excellence: Maintain HIPAA confidentiality, meet productivity benchmarks, stay current with billing policies, and manage workload with strong time management, organization, and communication skills.

PREFERRED QUALIFICATIONS:

• High school graduate or equivalent

• Bachelor’s degree in healthcare or business administration

• Minimum 1 year medical billing and denials, customer service and relevant finance experience in a health care organization a plus

• Certification in medical billing

UNION:

1199 SEIU (GH)

Note: Not all per diem roles are union eligible

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:

S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$20.26 - $29.40

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.