Senior Medical Billing Specialist

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Job Title: Senior Medical Billing Specialist

Location: Remote

Time Zone: US Time Zones (EST–PST)

Position Summary The Senior Medical Billing & Denial Management Specialist is a critical contributor to Rooted Life's Revenue Cycle Management (RCM) operations. This role ensures accurate, timely claims submission and takes primary ownership of resolving billing denials, rejections, and clearinghouse errors. Working hands-on with payers, the clearinghouse, and the EHR, this position validates clinical documentation, corrects claim issues, and secures reimbursement. Exceptional attention to detail, strong follow-through, and a proactive approach are essential to move claims through the full billing cycle efficiently and compliantly.

Key Responsibilities

Claims Submission & Daily Billing Operations

• Prepare and submit clean claims on a continual basis for all service lines (ECM, Community Supports, Housing Navigation, etc.), ensuring timely submission.

• Validate all claims against clinical documentation in , including encounter notes, service timelines, eligibility, and required fields.

• Monitor daily clearinghouse reports for rejections and errors; correct and resubmit promptly.

• Maintain claims submission schedules to meet payer deadlines and internal billing cycles.

Denials, Rejections & Payer Resolution (Primary Responsibility)

• Take full ownership of denials, rejections, and unpaid claims—ensuring root-cause resolution and successful resubmission.

• Contact payers directly to resolve issues related to authorizations, eligibility, coding, coordination of benefits, missing documentation, and system errors.

• Work with the clearinghouse to identify transmission issues, file format errors, and claim routing problems.

• Document all denial reasons, corrective actions, and payer communications in internal trackers.

• Analyze denial trends and escalate systemic issues to the Revenue Cycle Manager.

• Ensure corrected claims are resubmitted within required payer timelines.

Documentation & Clinical Validation

• Cross-check claims against clinical encounters to ensure documentation supports the billed service.

• Verify all required data elements (encounter type, duration, service location, care manager documentation, and signatures) meet payer and CalAIM compliance requirements.

• Flag and communicate documentation gaps to the care team and Revenue Cycle Manager.

• Assist in quality assurance reviews of clinical documentation and coding completeness.

Revenue Cycle & Reporting Support

• Maintain accurate billing logs, denial trackers, and A/R aging reports.

• Support month-end reconciliation of payments, adjustments, and unresolved claims.

• Assist in preparing reports on claim submission volumes, denial rates, payer trends, and days-in-A/R.

• Contribute to continuous improvement of RCM workflows, SOPs, and billing policies.

Cross-Department Coordination

• Collaborate with Authorization Specialists to verify approval status before billing.

• Communicate frequently with Care Managers, Supervisors, and the Admissions team to ensure all required documentation is available for compliant billing.

• Provide feedback to clinical teams on common documentation or encounter issues that delay billing.

• Participate in RCM meetings and trainings to maintain alignment across teams.

Qualifications

• 3–5 years of medical billing, claims follow-up, or payer resolution experience (Medi-Cal/Medicaid preferred).

• Demonstrated experience working claims through clearinghouses, payers, and denial management systems.

• Strong understanding of CPT/HCPCS codes, modifiers, ICD-10 codes, and Medicaid billing requirements.

• Experience validating claims within an EHR system ( experience highly preferred).

• Strong Excel/Google Sheets skills—filters, VLOOKUP, and pivot tables preferred.

• Excellent written and verbal communication skills; ability to navigate payer conversations professionally.

• Highly organized, detail-oriented, and skilled at managing multiple claim queues simultaneously.

Core Competencies

• Persistence & Follow-Through – Sees every claim through to resolution; closes loops quickly.

• Ability to Work Independently – Consistently manages workload with minimal supervision, demonstrating strong problem-solving, sound judgment, and reliable follow-through.

• Self-Directed – Takes initiative to identify needs, prioritize responsibilities, and proactively resolve issues without being prompted.

• Analytical Skills – Identifies root causes of denials and implements sustainable fixes.

• Accuracy & Quality – Produces clean, compliant claims with minimal error.

• Collaboration – Works smoothly with clinical, administrative, and payer teams.

• Systems Awareness – Understands how documentation, authorizations, encounters, and billing workflows connect.
  
  Please NOTE It is crucial that you complete the application form in full. As part of the application process, you will be required to record a video. If your application is successful, you will receive an email confirming next steps — the video is the first step of the interview process. If you do not record a video, we will not be able to consider you for ANY open roles.

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Originally posted on Himalayas