高级医疗计费专员
Senior Medical Billing Specialist
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职位名称：高级医疗账单专员
地点：远程办公
时区：美国时区（EST–PST）
职位概述 高级医疗账单与拒付管理专员是Rooted Life收入周期管理（RCM）运营的关键成员。该职位确保准确、及时地提交索赔，并负责解决账单拒付、拒绝和清算中心错误的主要责任。与保险公司、清算中心和Ritten.io http://Ritten.io EHR紧密合作，该职位验证临床文档，纠正索赔问题，并获得报销。出色的细节关注能力、强大的跟进能力和积极主动的态度对于高效且合规地推进索赔全流程至关重要。
主要职责
索赔提交与日常账单操作
- 持续为所有服务类别（ECM、社区支持、住房导航等）准备并提交干净的索赔，确保及时提交。
- 在Ritten.io http://Ritten.io 中验证所有索赔，包括就诊记录、服务时间线、资格和必填字段。
- 监控每日清算中心报告中的拒绝和错误；及时更正并重新提交。
- 维护索赔提交时间表，以满足保险公司的截止日期和内部账单周期。
拒付、拒绝与保险公司解决（主要职责）
- 全面负责拒付、拒绝和未付款索赔，确保根本原因解决并成功重新提交。
- 直接联系保险公司解决授权、资格、编码、利益协调、缺失文档和系统错误相关的问题。
- 与清算中心合作，识别传输问题、文件格式错误和索赔路由问题。
- 在内部跟踪器中记录所有拒付原因、纠正措施和保险公司沟通。
- 分析拒付趋势，并将系统性问题上报给收入周期经理。
- 确保更正后的索赔在保险公司的规定时间内重新提交。
文档与临床验证
- 核对索赔与Ritten.io http://Ritten.io 的临床就诊记录，确保文档支持所报服务。
- 验证所有必要数据元素（就诊类型、持续时间、服务地点、护理经理文档和签名）是否符合保险公司和CalAIM要求
查看英文原文
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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 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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