Appeals Specialist I

Rom Technologies•Clearwater, FL

2d•Onsite

About The Position

The Appeals Specialist supports ROMTech’s Revenue Cycle Management department by ensuring the timely, accurate, and compliant resolution of denied insurance claims. The role contributes to financial performance and patient access to care by optimizing reimbursement outcomes and following payer guidelines. It supports ROMTech’s clinician-guided at-home rehabilitation services by reviewing, appealing, and processing claims related to ROMTech devices. The position is classified as a W-2 employee and is non-exempt. It is performed in an office environment. The role also supports departmental process improvement, reporting, audits, reconciliation, and administrative needs.

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

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.
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.
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-specific requirements and established timelines.
Collaborate with billing, coding, and clinical teams to obtain documentation supporting appeals.
Interpret Explanation of Benefits (EOBs), payer policies, and reimbursement guidelines to support appeal decisions.
Monitor appeal status and follow up on unresolved, pending, or outstanding claims.
Maintain accurate, detailed records of appeals activity in designated system platforms.
Ensure compliance with payer regulations, internal policies, HIPAA requirements, and healthcare reimbursement standards.
Prioritize and manage multiple appeals 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-related reporting, audits, and reconciliation activities.
Provide general administrative support to the Revenue Cycle Management team as needed.
Participate in departmental meetings, training sessions, and professional development activities.
Perform other related duties as assigned to support operational and business needs.