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About the Role
The Claims Processing & Billing Specialist is responsible for the accurate and timely submission of institutional and professional medical claims. 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.
Requirements
- 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.
- Commitment to professionalism, teamwork, confidentiality, and excellent customer service.
Skills
- Raintree EMR system
- HIPAA
- Medical billing
- Revenue Cycle
Location
- Hybrid
Work Type
- Full-Time
Experience Level
- 3+ years
Education Level
- Bachelor's degree preferred
Salary/Compensations
- $23.64 - $25.51 per hour
Benefits
- 2 weeks PTO
- Sick time in accordance with state and local requirements
- 6 major holidays
- Company-matched 401(k)
- Pre-tax transit and parking benefits
- Pet Insurance with flexible plans, up to 90% reimbursement on eligible expenses, and 24/7 telehealth support
- Exclusive discounts through PlumBenefits and LifeMart
Equal Opportunity
- Equal Opportunity Employer, including Disabled/Veterans.