# Claims Processing & Billing Specialist

> Professional Physical Therapy · Melville, United States (Hybrid) · Full-time · Posted 2026-07-31

**Workplace:** hybrid

**Department:** Corporate

## Description

### Claims Processing & Billing Specialist

**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.

### What You'll Bring

-   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.

### Benefits

**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._

## Apply

[Apply at Professional Physical Therapy](https://apply.workable.com/professional-pt/j/E80D6C4C72/apply)

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