Medical Billing & Denials Specialist

Rochester Regional Health; Town of Canton (NY); On-site; USD 28,000 - 41,000; Full time

Job summary

Rochester Regional Health in Canton, NY is seeking a Medical Billing & Denials Specialist to ensure patient/insurance data, charges, and follow-up are accurate and timely. You will prepare and submit claims, retrieve status from payer portals, and work denials to secure prompt reimbursement.

The role requires understanding billing guidelines and medical terminology, collaboration across departments, and a focus on HIPAA compliance, productivity, and strong time management.

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

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.

Skills

Customer service

Attention to detail

Education

High school graduate or equivalent

Bachelor's degree in healthcare or business administration

Certification in medical billing

Job description

Job Title:

Medical Billing & Denials Specialist

Department:

Patient Financial Services

Location:

6196 U.S 11, Canton, NY 13617

Hours Per Week:

40

Schedule:

M-F, 8am-4:30pm

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

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.

Pay Range:

$20.26 - $29.40 The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, clinical licensure date, 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.