Medical Billing & Denials Specialist at Rochester Regional Health – CANTON, New York

Job Title: Medical Billing & Denials Specialist
Department: Patient Financial Services
Location: SLH - Regional Administrative Campus
Hours Per Week: 37.5
Schedule: 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 Expertise: Proficient in billing, claims processing (Inpatient, Outpatient, Critical Access, Rural Health), denials management, and knowledge of medical terminology, physician fee schedules, DRGs, and reimbursement procedures.

• Claims and Appeals Processing: Submits and follows up on insurance claims; resolves denials and rejections; prepares appeal letters with proper documentation and cross-department coordination.

• Account Management & Collections: Retrieves and updates patient account statuses, processes remittances, manages A/R, ensures accurate charge entry, and performs financial analysis to support revenue goals.

• Communication & Customer Service: Answers patient and payer inquiries, verifies insurance eligibility and authorizations, documents account activity, and maintains confidentiality in compliance with HIPAA.

• Operational Efficiency: Utilizes EMR systems, adheres to productivity benchmarks, meets deadlines, and demonstrates strong organizational, multitasking, and communication skills.

PREFERRED QUALIFICATIONS:

• Bachelor’s degree in healthcare or business administration

• Experience in medical billing and denials, customer service and relevant finance experience in a health care organization a plus

• Certification in medical billing

PHYSICAL REQUIREMENTS: S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

PAY RANGE: $20.66 - $29.99

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.