Medical Billing & Denials Specialist

Rochester General Hospital; United States; On-site; USD 28,000 - 41,000; Full time

Benefits offered by this job

Union representation 1199-200B SEIU

Job summary

Rochester Regional Health seeks a Medical Billing & Denials Specialist for the Patient Accounting department at the Canton, NY campus. The role involves managing claims, pursuing denials, and ensuring timely reimbursement within HIPAA guidelines.

Responsibilities include submitting/tracking claims, performing appeals, handling patient inquiries, and maintaining accurate documentation across Revenue Cycle teams.

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

• 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, gather supporting documentation.
• Respond to patient inquiries, verify insurance eligibility and authorizations, document clearly across Revenue Cycle teams.
• Maintain HIPAA confidentiality, meet productivity benchmarks, stay current with billing policies, manage workload with time management, organization, and communication skills.

Skills

Customer service

Communication

Time management

Attention to detail

Education

Bachelor's degree in healthcare or business administration

High school diploma or equivalent

Job description

Job Title: Medical Billing & Denials Specialist

Department: Patient Accounting

Location: SLH - Regional Administrative Campus, 6196 U.S. 11, Canton, NY 13617

Hours Per Week: 37.5

Schedule: Mon-Fri 8am -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.

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 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.