What are the responsibilities and job description for the Medical Billing Appeals Specialist position at CH Revenue Management Solutions(CHRMS)?
CH Revenue Management Solutions (CHRMS) is seeking an Out-of-Network Medical Billing Appeals Specialist to join its growing team. CHRMS represents out-of-network surgeons throughout the United States in the claim reimbursement cycle, from medical billing through appeals, including claims through the arbitration process under Federal and State laws. Our team is comprised of more than 50 professional medical billers, coders, insurance industry professionals, medical practice managers and ERISA and state regulatory experts. This opportunity is for the right individual looking to be part of an entrepreneurial work environment with a good work/life balance.
The Out-of-Network Medical Billing Appeals specialist is responsible for denial and appeals claim processing for medical providers and facilities, ensuring compliance with contractual obligations and State and Federal laws and regulations and generating appeals for denied or underpaid claims. If you are looking for a change to a more claim specific appeals process based on pursuing medical and legal strategies, this opportunity is for you.
MUST have experience with out-of-network reimbursement and be a strong writer.
This is a full time in-office position.
Key Responsibilities
- Validate denial code/reasons following explanation of benefit (EOB) review and ensure coding is accurate and reflects the procedures billed
- Analyze all coding adjustments made on EOB to ascertain accuracy and valid support
- Review Summary Plan Descriptions and related insurance documents to ascertain benefits
- Determine and execute best approach for denial resolution and processing appeal
- Ensure timeliness of all appeals according to Federal, State and plan guidelines
- Generate appeals based on the dispute reason(s)
- Document all actions taken during the appeal process and any follow-up required
- Request and obtain medical records, notes and/or copy of claim as appropriate
- Resolve appeal claims with third party payers
- Assist with Appeals Team efforts to coordinate problem solving in an efficient and timely manner
Knowledge, Skills and Abilities
- Proficiency in Microsoft Office programs, especially Excel, Word and Outlook version 2007
- Comprehensive knowledge of health care customer service, regulatory requirements and Provider Dispute and/or Member Appeal process.
- Working knowledge and a thorough understanding of denial resolution strategies and payer reimbursement specifics
- Knowledge of CPT/HCPC, ICD9/10 coding, procedures and guidelines
- Comprehensive analytical skills
- Excellent vocabulary, grammar, spelling, punctuation, and composition skills proven through the development of written communication
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) and fraud and abuse prevention detection policies and procedures
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
- Strong knowledge and experience in the out-of-network insurance world
- Must be a strong writer
Minimum Requirements
- High school diploma or equivalency
- At least 3 years of medical coding/billing/appeals experience
- MUST have experience in out-of-network reimbursement
Salary and Benefits
- From $26/hour
EOE/DFWP
Job Type: Full-time
Pay: From $26.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Experience:
- Out-of-network medical billing and appeals: 3 years (Preferred)
Work Location: In person