Billing Specialist

Apploi; New York (NY); On-site; USD 42,000 - 60,000; Full time

Job summary

Apploi, based in New York, is seeking a Medical Billing Specialist to support the Revenue Cycle Management team in day-to-day billing and collections for the practice.

In this office-based role in Far Rockaway, the specialist will manage accounts, follow up on outstanding claims, resolve denials, prepare resubmissions, and collaborate with clinical and administrative staff to maximize reimbursement from commercial and government payers.

Qualifications

• Proven experience with medical billing in a physician's office or billing company.
• Knowledge of payer requirements and government programs.

Responsibilities

• Review and follow up on outstanding insurance claims to facilitate timely reimbursement.
• Work assigned accounts receivable and identify claims requiring additional action.
• Investigate unpaid, underpaid, rejected, or unresolved claims.
• Contact insurance carriers to determine claim status and identify outstanding requirements.
• Correct billing errors and prepare claims for timely resubmission.
• Monitor previously corrected or resubmitted claims through resolution.
• Assist with identifying recurring billing issues and communicate trends to the Director.
• Maintain accurate documentation of billing activity and communications.
• Review insurance denials and determine next steps for resolution.
• Prepare first-level appeals and supporting documentation as required.
• Follow appeals through resolution and perform additional follow-up as necessary.

Skills

Medical billing

Claims follow-up

Denials & appeals

Tools

Billing software

Payer portals

Job description

Medical Billing Specialist

Department: Revenue Cycle Management
Reports To: Director of Revenue Cycle Management
Position Type: Full-Time
Location: Far Rockaway, NY (Office Based Role, not a Remote Position)

Position Summary

The Medical Billing Specialist is an experienced, hands-on member of the Revenue Cycle Management team responsible for supporting the Director of Revenue Cycle Management in the day-to-day billing and collections functions of the practice.

This position is intended for an individual with a strong working knowledge of medical billing who can independently manage assigned accounts, identify billing issues, work denials, follow up on outstanding claims, prepare resubmissions and appeals, and assist in maximizing appropriate reimbursement from commercial and government payers.

The ideal candidate will have experience working within a physician's office, outpatient medical practice, specialty practice, or medical billing company. Experience in a smaller, fast-moving healthcare environment is particularly valuable, as the position requires adaptability, organization, independent problem-solving, and direct communication with clinical and administrative team members.

This role will work closely with and under the direction of the Director of Revenue Cycle Management. The Medical Billing Specialist is expected to possess greater experience and independent billing capability than an entry-level or general biller, while escalating complex reimbursement, coding, contractual, and revenue-cycle matters to the Director or appropriate senior RCM personnel.

Essential Duties and Responsibilities

Claims Management & Follow-Up

• Review and follow up on outstanding insurance claims to facilitate timely and accurate reimbursement.
• Work assigned accounts receivable and identify claims requiring additional action.
• Investigate unpaid, underpaid, rejected, or otherwise unresolved claims.
• Contact insurance carriers as necessary to determine claim status and identify outstanding requirements.
• Correct billing errors and prepare claims for timely resubmission.
• Monitor previously corrected or resubmitted claims through resolution.
• Assist with identifying recurring billing issues and communicate trends to the Director of Revenue Cycle Management.
• Maintain accurate documentation of billing activity, payer communications, claim status, and follow-up actions.

Denials & Appeals

• Review insurance denials and determine the appropriate next steps for resolution.
• Identify denial reasons, including coding issues, authorization problems, eligibility concerns, filing limitations, medical necessity issues, documentation requests, and payer processing errors.
• Correct and resubmit claims when appropriate.
• Prepare first-level appeals and supporting documentation in accordance with payer requirements.
• Follow appeals through resolution and perform additional follow-up as necessary.