Medical Claims Specialist

CH Revenue Management Solutions (CHRMS) is seeking a Medical Claims 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 Medical Claims Specialist is responsible for reviewing claims from a diverse group of surgical specialists and assisting in the processing of these claims for further reimbursement through appeals and independent dispute resolution.

CHRMS promotes growth within the organization based upon experience, knowledge and demonstrated results.

This is a full-time in office position.

Key Responsibilities

• Analyze claim documents received from clients.
• Follow up with clients for additional medical file documentation.
• Review EOBs and claim files for denial resolution and processing claims for additional reimbursement.
• Determine claim pathway whether through appeals, IDR or other means.
• Maintain knowledge of Company’s processes and policies in preparing appeals, IDR statements and other documents for filing.
• Prepare all documents for filing with proper parties.
• Initiate negotiations and IDR proceedings and follow-up requirements.
• Document all actions taken through Company’s software platforms.
• Work together with team in problem solving and strategies.

Knowledge, Skills and Abilities

• Proficiency in Microsoft Office programs, especially Excel, Word and Outlook.
• Knowledge of health care customer service, regulatory requirements and/or Provider/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.
• Knowledge of out-of-network reimbursement.
• Good writing skills.

Minimum Requirements

• High school diploma or equivalency
• At least 3 years of medical coding/billing/appeals experience

Salary and Benefits

• From $24.00/ hour
• We offer our team paid time off, medical, dental, vision, 401(k) with match, LTD, STD, FSA, Pet Wellness Plans, and supplemental insurance plans.

EOE/DFWP

Job Type: Full-time

Pay: From $24.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• medical coding/billing/appeals: 3 years (Preferred)

Ability to Commute:

• Tinton Falls, NJ 07724 (Required)

Work Location: In person

Salary : $24