Hospital Billing & Claims Specialist

About the role

Full-Time | Hybrid Hourly Rate: $23.64 - $25.51 (commensurate with experience). The Claims Processing & Billing Specialist is responsible for the accurate and timely submission of institutional and professional medical claims. Reporting to the Manager of Claims Processing & Credentialing, this role reviews claims in the Raintree EMR system, resolves billing edits and clearinghouse exceptions, and works closely with payers, patients, providers, and internal teams to support efficient reimbursement.

Responsibilities

• Submit accurate institutional (UB-04) and professional (CMS-1500) claims to commercial and government payers
• Review and resolve claim edits, billing errors, clearinghouse exceptions, and rejections
• Submit corrected claims and ensure successful claim transmission to payers
• Verify patient eligibility and resolve coverage or demographic discrepancies prior to claim submission
• Communicate with insurance carriers, patients, providers, and internal teams to resolve billing issues
• Complete billing reviews, post splint charges, and enter charges into the DOL and Claim Connect portals
• Monitor claims processing inboxes and follow up on outstanding clearinghouse responses
• Navigate the Raintree EMR system to resolve claim issues and document account activity
• Meet departmental productivity and quality standards while maintaining compliance with HIPAA and other applicable regulations
• Stay current on payer policies and billing guidelines
• Perform other duties and special projects as assigned

Qualifications

• 3+ years of Revenue Cycle or medical billing experience
• Strong knowledge of institutional (UB-04) and professional (CMS-1500) billing
• Experience with commercial and government insurance payers
• Proficiency with the Raintree EMR system
• Strong analytical, organizational, and problem-solving skills with exceptional attention to detail
• Proven ability to manage multiple priorities, work independently, and consistently meet productivity goals
• Cross-functional Revenue Cycle experience is a plus
• Bachelor's degree preferred
• Commitment to professionalism, teamwork, confidentiality, and excellent customer service

Benefits

• Rest, Reset & Recharge: 2 weeks PTO; Sick time in accordance with state and local requirements; plus 6 major holidays
• Plan Ahead: Company-matched 401(k) once eligibility requirements are met
• Commute Smart: Pre-tax transit and parking benefits through WageWorks (for eligible in-office employees)
• Care for Your Crew: MetLife Pet Insurance with flexible plans, up to 90% reimbursement on eligible expenses, and 24/7 telehealth support
• Play More, Pay Less: Exclusive discounts through PlumBenefits and LifeMart on travel, entertainment, shopping, dining, and more