Medical Billing & Denials Specialist

Job Title: Medical Billing & Denials Specialist

Department: Financial Services

Location: SLH-MH Main: 1 Hospital Drive, Massena, NY 13662

Hours Per Week: 40Hrs

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 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

UNION:

CSEA (MH)

Note: Not all per diem roles are union eligible

EDUCATION:

LICENSES / CERTIFICATIONS:

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:

$20.26 - $29.40

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.