Senior Medical Billing Specialist

Join [Hire Hangar](https://himalayas.app/companies/hire-hangar) and work with fast-growing global companies while building a long-term career. ### **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 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. We connect top talent with vetted employers, competitive pay, and real growth opportunities. Originally posted on [Himalayas](https://himalayas.app)