CH Revenue Management Solutions (CHRMS) is seeking an out-of-network Medical Billing Appeals Specialist to support the claim reimbursement cycle for out-of-network surgeons across the United States. The role focuses on denial and appeals claim processing, helping ensure compliance with contractual obligations and applicable state and federal regulations.
This position involves researching denied or underpaid claims, preparing appeals, and working through the arbitration process when needed. The team operates in an entrepreneurial environment with an emphasis on work/life balance.
Requirements & Qualifications
Key responsibilities
- Validate denial codes and reasons using explanation of benefits (EOB) reviews
- Analyze coding adjustments on EOBs for accuracy and supporting documentation
- Review Summary Plan Descriptions and related insurance documents to determine benefits
- Determine and execute the best approach for denial resolution and appeal processing
- Ensure appeals are submitted within federal, state, and plan deadlines
- Prepare appeals based on the dispute reason
- Document all actions and follow-up steps during the appeals process
- Request and obtain medical records, notes, and copies of claims as needed
- Resolve appeal claims with third-party payers
- Support the Appeals Team in problem-solving and timely processing
Knowledge, skills, and qualifications
- Proficiency with Microsoft Office, especially Excel, Word, and Outlook
- Strong understanding of healthcare customer service and regulatory requirements
- Knowledge of provider dispute and/or member appeal processes
- Working knowledge of denial resolution strategies and payer reimbursement processes
- Familiarity with CPT/HCPC, ICD-9/10 coding, procedures, and guidelines
- Strong analytical skills
- Excellent vocabulary, grammar, spelling, punctuation, and composition skills
- Ability to maintain confidentiality and follow HIPAA and fraud prevention policies
- Strong relationship-building and communication skills
- Experience in the out-of-network insurance environment
- Strong written communication skills
Minimum requirements
- High school diploma or equivalent
- At least 3 years of medical coding, billing, or appeals experience
- Must have experience with out-of-network reimbursement
Benefits & Perks
Benefits
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
4 years ago