Medical Billing & Denials Specialist

Rochester Regional Health

8d • $20 - $29 • Onsite

About The Position

The Medical Billing & Denials Specialist manages the billing process, submits claims to insurance companies, follows up on unpaid or denied claims, and supports timely reimbursement for healthcare services. The role contributes to revenue cycle management by identifying denial trends and taking corrective action. It includes claims processing across inpatient, outpatient, critical access, and rural health services; denial resolution and appeals; patient account and accounts receivable management; and communication with patients and payers. The specialist uses EMR systems, meets productivity benchmarks and deadlines, and maintains confidentiality in compliance with HIPAA. The position is based at SLH - MH - MAIN, 1 Hospital Drive, Massena, NY 13662, and is scheduled Monday through Friday, 8 a.m. to 4 p.m., for 40 hours per week.

This is primarily an office-based, sedentary role requiring prolonged sitting, fine motor skills for computer work, writing, and telephone use, and clear visual and auditory ability. The job involves sustained concentration, frequent interruptions, independent decision-making, and information processing. Administrative areas in healthcare settings may involve occasional exposure to infectious agents. Accommodations will be considered for physical requirements reported by an employee or prospective employee and their physician or delegate.

Requirements

• Proficiency in medical billing, claims processing, and denials management.
• Knowledge of medical terminology, physician fee schedules, DRGs, and reimbursement procedures.
• Ability to prepare appeals with proper documentation and coordinate across departments.
• Ability to manage patient accounts and accounts receivable, process remittances, and ensure accurate charge entry.
• Ability to respond to patient and payer inquiries and verify insurance eligibility and authorizations.
• Ability to use EMR systems, meet productivity benchmarks and deadlines, and maintain confidentiality in compliance with HIPAA.

Nice To Haves

• Bachelor’s degree in healthcare or business administration.
• Experience in medical billing and denials, customer service, or relevant finance experience in a healthcare organization.
• Certification in medical billing.

Responsibilities

• Submit and follow up on insurance claims, including inpatient, outpatient, critical access, and rural health claims.
• Resolve claim denials and rejections, prepare appeal letters with appropriate documentation, and coordinate with other departments.
• Retrieve and update patient account statuses, process remittances, manage accounts receivable, and ensure accurate charge entry.
• Perform financial analysis to support revenue goals and identify denial trends requiring corrective action.
• Answer patient and payer inquiries and verify insurance eligibility and authorizations.
• Document account activity and maintain confidentiality in compliance with HIPAA.
• Use EMR systems, meet productivity benchmarks and deadlines, and maintain effective organization, multitasking, and communication.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed