Appeals Specialist I

ROM TECHNOLOGIES INC•Clearwater, FL

3d•$20 - $23•Onsite

About The Position

The Appeals Specialist supports ROMTech’s Revenue Cycle Management operations by ensuring timely, accurate, and compliant resolution of denied insurance claims. The role contributes to reimbursement outcomes and patient access to care by reviewing, appealing, and tracking claims related to ROMTech devices in accordance with payer guidelines. The position is based in an office in Clearwater, Florida, and reports to the Appeals Manager. It is a W-2, non-exempt employee position.

Requirements

Experience in medical billing, claims processing, insurance follow-up, or revenue cycle management.
Excellent written and verbal communication skills.
Strong analytical and problem-solving abilities.
Ability to work independently and manage multiple priorities.
High attention to detail and accuracy.
Ability to interpret insurance guidelines, payer policies, and reimbursement requirements.
Proficiency with computer systems and claims or appeals tracking tools.
Strong organizational and time-management skills.
Ability to maintain confidentiality and handle sensitive information appropriately.

Nice To Haves

Familiarity with medical device billing and reimbursement processes.
Experience with revenue cycle management systems or EHR platforms.
Knowledge of payer-specific appeal strategies and regulatory requirements.
Understanding of Medicare, Medicaid, and commercial insurance reimbursement processes.
Experience in a medical device, healthcare, or provider organization.
Prior experience managing insurance appeals and denial resolutions.
Experience working with multiple payer types and reimbursement methodologies.
High school diploma or equivalent.
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Revenue Cycle Representative (CRC), or similar coding, billing, or revenue cycle certification.

Responsibilities

Review and analyze denied insurance claims to determine appropriate appeal strategies.
Prepare, submit, and track appeals according to payer requirements and established timelines.
Collaborate with billing, coding, and clinical teams to obtain supporting appeal documentation.
Interpret Explanation of Benefits (EOBs), payer policies, and reimbursement guidelines to inform appeal decisions.
Monitor appeal status and follow up on unresolved, pending, or outstanding claims.
Maintain accurate, detailed appeal records in designated systems.
Ensure compliance with payer regulations, internal policies, HIPAA requirements, and healthcare reimbursement standards.
Prioritize and manage multiple appeal cases while meeting productivity and quality expectations.
Research payer requirements and identify opportunities to improve reimbursement outcomes.
Communicate with insurance carriers and internal stakeholders about appeal status and resolution.
Support Revenue Cycle Management process-improvement initiatives.
Assist with claims and appeals reporting, audits, and reconciliation activities.
Provide general administrative support to the Revenue Cycle Management team as needed.
Participate in departmental meetings, training, and professional development activities.
Perform other related duties as assigned to support operational and business needs.