Job Description

Hospital Billing & Claims Specialist

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Full-Time | Hybrid

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Hourly Rate: $23.64 - $25.51 (commensurate with experience)

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The Claims Processing & Billing Specialist is responsible for the accurate and timely submission of institutional and professional medical claims. Reporting to the Manager of Claims Processing & Credentialing, 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 effective reimbursement.

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What You'll Do

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- Submit accurate institutional (UB-04) and professional (CMS-1500) claims to commercial and government payers.
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- Review and resolve claim edits, billing errors, clearinghouse exceptions, and rejections.
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- Submit corrected claims and ensure successful claim transmission to payers.
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- Verify patient eligibility and resolve coverage or demographic discrepancies prior to claim submission.
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- Communicate with insurance carriers, patients, providers, and internal teams to resolve billing issues.
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- Complete billing reviews, post splint charges, and enter charges into the DOL and Claim Connect portals.
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- Monitor claims processing inboxes and follow up on outstanding clearinghouse responses.
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- Navigate the Raintree EMR system to resolve claim issues and document account activity.
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- Meet departmental productivity and quality standards while maintaining compliance with HIPAA and other applicable regulations.
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- Stay current on payer policies and billing guidelines.
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- Perform other duties and special projects as assigned.
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What You'll Bring

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- 3+ years of Revenue Cycle or medical billing experience.
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- Strong knowledge of institutional (UB-04) and professional (CMS-1500) billing.
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- Experience with commercial and government insurance payers.
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- Proficiency with the Raintree EMR system.
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- Strong analytical, organizational, and problem-solving skills with exceptional attention to detail.
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- Proven ability to manage multiple priorities, work independently, and consistently meet productivity goals.
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- Cross-functional Revenue Cycle experience is a plus.
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- Bachelor's degree preferred.
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- Commitment to professionalism, teamwork, confidentiality, and excellent customer service.
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Benefits

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Rest, Reset & Recharge: 2 weeks PTO; Sick time in accordance with state and local requirements; plus 6 major holidays.

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Plan Ahead: Company-matched 401(k) once eligibility requirements are met.

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Commute Smart: Pre-tax transit and parking benefits through WageWorks (for eligible in-office employees).

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Care for Your Crew: MetLife Pet Insurance with flexible plans, up to 90% reimbursement on eligible expenses, and 24/7 telehealth support.

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Play More, Pay Less: Exclusive discounts through PlumBenefits and LifeMart on travel, entertainment, shopping, dining, and more.

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Equal Opportunity Employer, including Disabled/Veterans.

📌 Hospital Billing & Claims Specialist (Melville)
🏢 Professional Physical Therapy
📍 Melville