Professional Physical Therapy

Systems Engineer

• Develop, optimize, and support Microsoft SQL Server solutions using advanced T-SQL, sound database design, and performance analysis
• Build and maintain SSRS reports, data imports, transformations, integrations, and queries across SQL Server
• Support report development within an existing BI environment using SQL Server and MySQL
• Maintain and enhance production applications within an existing C#/.NET environment
• Support integrations among applications, databases, and external systems via API and SFTP
• Build Copilot Studio agents and Power Automate workflows connecting Teams, SQL Server, APIs, knowledge sources, and internal systems
• Apply prompt-engineering and RAG techniques with appropriate testing, grounding, access controls, security, and responsible AI practices
• Partner with business and technical teams to turn operational needs into scalable solutions and clear documentation

Systems Developer

Claims Specialist

• 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

Hospital Billing & Claims Specialist

Accounts Receivable

• Review professional and institutional claims for accuracy, completeness, coding consistency, authorization status, and payer requirements
• Validate patient, provider, insurance, coding, and billing information for clean claim submission and accurate reimbursement
• Research and resolve claim edits, clearinghouse rejections, denials, underpayments, unpaid claims, billing discrepancies, and reimbursement issues
• Prepare and submit corrected, replacement, voided, and appealed claims according to payer guidelines and timely filing requirements
• Follow up on outstanding insurance and patient balances through final account resolution
• Research payer policies, reimbursement guidelines, and claim requirements using payer portals and available resources
• Review remittance advice, claim history, account documentation, and billing records to determine root causes and resolve payment issues
• Identify recurring denial trends and reimbursement issues, escalating process improvement opportunities to leadership
• Maintain accurate, timely documentation of account activity within the billing system
• Comply with organizational policies and regulatory requirements; perform other duties as assigned

Systems Developer

Hospital Billing & Claims Specialist

Hospital Account Receivable Specialist