Claims Processing & Billing Specialist
About this role
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.
What You'll Do- 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.
Company at a glance
Feeling better has never been more convenient -- with our state-of-the-art facilities in New York, New Jersey, Connecticut, Massachusetts and New Hampshire! At Professional Physical Therapy (Professional), we customize recovery plans for all of our patients and give them the flexibility to be treated in multiple locations during their rehabilitation. Our team of specialists includes physical therapists, certified athletic trainers, strength and conditioning specialists, hand therapists, and ergonomic workplace solutions experts.
To afford our patients with care that lasts beyond the rehabilitation process and to provide elite, adult, and youth athletes with the tools they need to succeed, in 2005, we launched the Professional Athletic Performance Center -- a 20,000 square foot facility on Long Island.
Professional offers one of the best Continuing Education programs for allied health professionals in the field of Sports Medicine -- Professional Seminars. We also provide students with an opportunity to augment their education in our clinics through our nationally renowned Clinical Affiliation Program.
At Professional, we recognize our staff is our most valuable asset. We invest in each employee and are proud of our many opportunities for career development.
We provide the highest quality care Physical Therapy has to offer! Call us today!
1-800-333-MYPT
Top Benefits
- Paid time off
- Sick time
- 6 major holidays
- 401(k) matching
- Pre-tax transit and parking benefits
- Pet insurance
- Telehealth support
- Travel discounts
- Entertainment discounts
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