Senior Billing Specialist

Description

Job Purpose: Join Denova Collaborative Health as a Senior Billing Specialist, where your expertise in complex medical billing and revenue cycle operations helps ensure clean, compliant claims and maximizes reimbursement. In this advanced role, you will take ownership of high-dollar and complex claims, identify root causes of recurring billing issues, recommend process improvements, and serve as a resource for the billing team. Your knowledge and leadership will directly support our mission of delivering integrated, whole-person healthcare while strengthening the efficiency and quality of our revenue cycle.

This position is non-exempt and will report to the RCM System & Solution Mgr

What You Will Do:

Complex Claim Ownership

• Complex Claim Ownership
• Manage complex, high-dollar, and aged claims that require advanced billing knowledge.
• Resolve escalated clearinghouse rejections, payer-specific edits, and coordination of benefits (COB) claim issues.
• Process corrected claims and rebill complex claim types while ensuring timely filing compliance.
• Handle specialized billing scenarios including split claims, interim bills, and secondary and tertiary payer submissions.

Edit Analysis & Process Improvement

• Analyze recurring claim edits and rejection trends to identify root causes across payers and claim types.
• Recommend scrub-rule and edit-logic improvements in collaboration with Business Systems Support.
• Validate the effectiveness of scrub-rule updates before implementation.
• Document findings, trends, and financial impact to support continuous process improvement.

Team Support & Collaboration

• Serve as a subject matter expert for Billing Representatives by providing guidance on payer rules, coding, modifiers, and claim edits.
• Support onboarding and mentor newer team members through informal coaching and knowledge sharing.
• Maintain and update departmental billing procedures, workflows, and job aids.
• Collaborate with leadership and cross-functional teams to improve billing accuracy and operational efficiency.

Additional Responsibilities

• Meet advanced productivity and quality standards while managing complex work.
• Participate in and help lead process improvement initiatives.
• Perform other related duties as assigned.

What We Need From You:

Education

• High School Diploma or GED required.
• Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
• Certified Professional Coder (CPC) strongly preferred.
• HFMA CRCR certification or other relevant healthcare revenue cycle certification is preferred.

Experience

• Three or more years of healthcare revenue cycle, medical billing, or claims management experience with demonstrated accuracy and strong performance.
• Experience with Electronic Health Records (EHR) and practice management systems, preferably AMD.

Skills & Knowledge

• Advanced knowledge of medical billing, insurance claims, CPT, HCPCS, ICD-10 coding, payer regulations, and reimbursement processes.
• Strong analytical and problem-solving skills with the ability to resolve complex billing issues.
• Ability to identify process improvement opportunities and recommend effective solutions.
• Excellent organizational, communication, and leadership skills.
• Ability to mentor team members while working independently on advanced assignments.
• Commitment to maintaining HIPAA compliance and protecting patient information.
• Must be located in Arizona.

What Success Looks Like:

Our Senior Billing Specialists lead by example through accuracy, collaboration, and continuous improvement. Success in this role includes:

• Achieving a 95% or higher clean claim first-pass acceptance rate on complex claims.
• Meeting advanced productivity expectations while maintaining exceptional quality.
• Resolving escalated claims within established service standards.
• Identifying and documenting root-cause trends that improve claim quality and reduce denials.
• Supporting the growth and success of the billing team through mentorship and process improvements.

Your Work Schedule:

• Monday to Friday, 8 AM - 4:30 PM (Flexible)
• Location: Denova Collaborative Health LLC - DHQ (Hybrid Work Model after 90 days)

Perks of Being Part of Denova:

• Comprehensive low-cost medical, dental, and vision insurance.
• Generous retirement plan with a 3.5% company match.
• Secure your future with both long and short-term disability options
• Enjoy holiday pay, PTO, and life insurance benefits.
• We offer an employee wellness program and fantastic discounts for all Denova team members.
• And there's so much more waiting for you!

Our Revenue Cycle Mission Our Revenue Cycle team removes friction from the financial side of healthcare so our clinicians can focus on care and our patients can focus on healing.

We succeed when claims go out clean the first time, payments are posted quickly and accurately, denials are prevented, patients understand their responsibility, and team members feel supported. At Denova, we believe: people first, process second, technology third.

Denova Collaborative Health LLC is an integrated primary care and behavioral health practice based in the Greater Phoenix metropolitan area. Our comprehensive virtual care services are available for residents throughout the entire state of Arizona.

We provide a “whole person” approach to health and promote collaboration among our team of primary care providers and specialists. Our unique service integration of primary care, behavioral health, addiction medicine, and wellness enables our team to provide better health outcomes.