Collections & Denials Management Representative

St. Lawrence Health System; Town of Canton (NY); On-site; USD 29,000 - 41,000; Full time

Job summary

Rochester Regional Health in Canton, NY is seeking a Medical Billing and Denials Specialist to manage the billing process within the Revenue Cycle department. The role involves submitting claims, following up on denials, and ensuring timely reimbursement for clinical services.

You will identify denial trends, collaborate across departments, and uphold HIPAA standards while maintaining accurate documentation and strong communication with patients and payers.

Qualifications

• Minimum 1 year medical billing and denials experience.
• Customer service experience in healthcare setting.
• Certification in medical billing is a plus.

Responsibilities

• Submit and track insurance claims, resolve denials and billing edits.
• Process remittances and adjustments with payer requirements.
• Conduct appeals and gather supporting documentation.
• Respond to patient inquiries and verify insurance eligibility.

Skills

Billing & Denials

Customer Service

Education

Bachelor's degree in healthcare or business administration

High school graduate or equivalent

Job description

Job Title: Medical Billing and Denials Specialist Department: Revenue Cycle Location: SLH Regional Administrative Campus 6196 US 11 Canton, NY Hours Per Week: 37.5 Schedule: Monday - Friday 8 am - 4pm

SUMMARY:

A Medical Billing and Denials Specialist is responsible for managing the billing process, submitting claims to insurance companies, following up on unpaid or denied claims, and ensuring timely reimbursement for healthcare services. This role plays a critical part in the revenue cycle management of the healthcare organization by identifying trends in denials and taking corrective actions.

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.

REQUIRED QUALIFICATIONS:

None

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:

1199-200B SEIU (CPH)

Clerical Note:

Not all per diem roles are union eligible

PHYSICAL REQUIREMENTS:

Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision‑making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license. 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:

$20.66 - $29.99 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.

Rochester Regional Health is an integrated health services organization serving the people of Western New York, the Finger Lakes, St. Lawrence County, and beyond. The system includes nine hospitals; primary and specialty practices, rehabilitation centers, ambulatory campuses and immediate care facilities; innovative senior services, facilities and independent housing; a wide range of behavioral health services; and Rochester Regional Health Laboratories and ACM Global Laboratories, a global leader in patient and clinical trials. It’s vision is to lead the evolution of healthcare to enable every member of the communities it serves to enjoy a better, healthier life.