Medical Reimbursement Specialist

CH Revenue Management Solutions (CHRMS) is seeking a Medical Reimbursement 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 Reimbursement Specialist is responsible for analyzing claim data, preparing arbitration statements and appeals and ensuring compliance by payors with contractual obligations, and the independent dispute resolution process.

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 be a strong writer.

FULL TIME IN OFFICE IS REQUIRED.

Key Responsibilities

• Review explanation of benefits (EOB) and ensure coding is accurate and reflects the procedures performed.
• Analyze all coding adjustments made on EOB to ascertain accuracy and valid support.
• Review client claim information and related insurance documents.
• Determine and execute best approach for claim pathway, whether through appeals, IDR or other means.
• Preparing documents in a timely manner to comply with filings, Federal, State and plan guidelines.
• Maintain knowledge of Company’s strategies, processes and policies in preparing appeals, IDR statements and other documents.
• Document all actions taken in the Company’s database and any follow-up required.
• Request and obtain medical records, notes and/or copy of claim as appropriate.

Knowledge, Skills and Abilities

• Proficiency in Microsoft Office programs, especially Excel, Word and Outlook.
• 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.
• Knowledge and experience in the out-of-network insurance world.

Minimum Requirements

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

Salary and Benefits

• Starting at $27/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 $27.00 per hour

Expected hours: 40 per week

Benefits:

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

Experience:

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

Ability to Commute:

• Red Bank, NJ 07701 (Required)

Work Location: In person