Claims Processing & Billing Specialist

Full-Time | Hybrid

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

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 efficient reimbursement.

• 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.

• 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.
• Bachelor's degree preferred.
• Commitment to professionalism, teamwork, confidentiality, and excellent customer service.

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

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

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

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

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

Equal Opportunity Employer, including Disabled/Veterans.