Medical Billing & Denials Specialist

Summary

The Medical Billing & Denials Specialist ensures accuracy, completeness, and timeliness in patient/insurance information, charges, billings, and account resolutions. Duties include preparing and submitting claims, working denials, and gathering necessary documentation for appeals.

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.

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 (preferred)

• Certification in medical billing (preferred)

• Union 1199 SEIU (GH) preference (not all per diem roles are union eligible)

Preferred Qualifications

• Union 1199 SEIU (GH) preference (not all per diem roles are union eligible)

Physical Requirements

• Sedentary Work: Exerting up to 10 pounds of force occasionally. Sitting most of the time, but may involve walking or standing for brief periods of time.

Pay

• $20.26 - $29.40 per hour