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

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

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.

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.