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. The team includes more than 50 professional medical billers, coders, insurance industry professionals, medical practice managers, and ERISA and state regulatory experts. This role suits individuals seeking an entrepreneurial environment with good work-life balance.

The Medical Reimbursement Specialist is responsible for analyzing claim data, preparing arbitration statements and appeals, and ensuring payor compliance with contractual obligations and the independent dispute resolution process.

Key responsibilities include reviewing explanation of benefits (EOB) to ensure accurate coding, analyzing coding adjustments, reviewing client claim information, determining optimal claim pathways (appeals, IDR, etc.), preparing documents timely to comply with Federal, State, and plan guidelines, maintaining knowledge of company strategies and policies related to appeals and IDR, documenting actions in the company database, and requesting medical records or claim copies as needed.

Candidates must be strong writers and proficient in Microsoft Office (Excel, Word, Outlook). They should have comprehensive knowledge of healthcare customer service, regulatory requirements, provider dispute, and member appeal processes, with experience in denial resolution strategies, payer reimbursement specifics, CPT/HCPC, ICD9/10 coding, procedures and guidelines. Excellent written communication skills and confidentiality in compliance with HIPAA and fraud and abuse prevention policies are required, along with the ability to maintain positive professional relationships and knowledge of out-of-network insurance practices.

Minimum qualifications include a high school diploma or equivalent and at least 3 years of medical coding, billing, or appeals experience.

Salary and benefits start at $27 per hour. Benefits include paid time off, medical, dental, vision insurance, 401(k) with match, LTD, STD, FSA, pet wellness plans, and supplemental insurance plans.

This position is full-time and requires working in the office.