Medical Billing & Denials Specialist

Rochester Regional Health; United States; On-site; USD 28,000 - 41,000; Full time

Job summary

Rochester Regional Health is seeking a Medical Billing & Denials Specialist in Canton, NY to ensure accurate, complete, and timely patient accounts. The role submits claims, tracks denials, and coordinates across departments to compile documentation for appeals.

The position requires 1 year of medical billing/denials experience; high school diploma or Bachelor's in healthcare/business; HIPAA compliance and strong communication are essential.

Qualifications

• High school graduate or equivalent; Bachelor's degree in healthcare or business administration preferred.
• 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: some per diem roles may not be union eligible.

Responsibilities

• Submit and track insurance claims, resolve denials and billing edits, process remittances and adjustments.
• Conduct detailed reviews of denied or underpaid claims, prepare appeal letters and gather supporting documentation.
• Respond to patient inquiries, verify insurance eligibility and authorizations, and maintain documentation for Revenue Cycle teams.
• Maintain HIPAA confidentiality and meet productivity benchmarks; manage workload with time management and organization.

Skills

Customer service

Communication

Time management

Education

High school graduate or equivalent

Bachelor's degree in healthcare or business administration

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 UNION: 1199 SEIU (GH) 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

PAY RANGE: $20.26 - $29.40 The posted pay range is a good faith representation of potential base pay for this position. It may be modified in the future and eligible for additional pay components. Individual annual salaries/hourly rates could vary based on position details and FTE. Pay is determined by considering factors including, but not limited to, experience, relevant qualifications, specialty, internal equity, locations, 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. Its vision is to lead the evolution of healthcare to enable every member of the communities it serves to enjoy a better, healthier life.