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 Ritten.io http://Ritten.io 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 Ritten.io http://Ritten.io, 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 Ritten.io http://Ritten.io 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 (Ritten.io http://Ritten.io experience highly preferre