CH Revenue Management Solutions (CHRMS)(forthesurgeons.com) is seeking a Medical Billing Accounts Receivable 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 65 professional medical billers, coders, insurance professionals, and industry 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 Billing Accounts Receivable Specialist is responsible for researching and resolving client provider A/R issues. This includes managing all aspects of reimbursement for out-of-network medical claims such as detailed follow-up with commercial payers, placing billing inquiries to company clients, negotiating payments based on UCR/fair market rates, handling disputes, maintaining and updating the company’s A/R database, and maximizing collections while ensuring compliance with state and federal regulations.
Experience with medical claims analysis and collections, A MUST.
FULL TIME IN OFFICE IS REQUIRED.
Key Responsibilities:
OON Claims Follow-Up
- Review aging reports to identify unpaid, underpaid, or stalled out-of-network claims.
- Contact insurance carriers to verify claim receipt, status, and expected allowable amounts.
- Work claims through all stages of adjudication including repricing, negotiation, and escalation.
Payment Negotiation & Repricing
- Evaluate payer offers and compare against UCR (Usual, Customary & Reasonable) rates or provider fee schedules.
- Negotiate higher reimbursement with insurance carriers and third-party negotiators.
- Document negotiation outcomes and counteroffers clearly and professionally.
Denial & Dispute Management
- Identify reasons for OON denials such as medical necessity, coding issues, or coverage limits.
- File appeals with supporting clinical and coding documentation.
- Escalate disputes to supervisors, payer representatives, or state regulatory bodies when appropriate.
Patient Responsibility & Balance Billing
- Determine correct patient responsibility based on plan benefits (deductible, coinsurance, OON limits).
- Ensure compliance with federal and state laws relating to surprise billing, No Surprises Act (NSA), and balance-billing rules.
- Communicate with providers regarding billing inquiries, discrepancies, and payment-related matters.
- Communicate with patients about balances, explanations of benefits (EOBs), and insurance determinations.
Payment Posting & Reconciliation
- Post insurance payments, adjustments, and patient payments accurately.
- Reconcile daily deposits and resolve posting discrepancies promptly.
- Review zero-pay EOBs to confirm appeal or follow-up needs.
Reporting & Documentation
- Maintain detailed notes for each claim interaction, negotiation step, and appeal outcome.
- Prepare reports on recovery rates, outstanding balances, and payer trends.
- Track closure rates for OON negotiations and disputes.
- Maintain organized records of invoices, payments, and other billing-related documents.
- Maintains client files and ensure necessary documentation is received, noted, and updated in CHRMS system.
- Generate reports for billing, open A/R, and others, as needed.
- Creating and maintaining spreadsheets and databases.
Compliance & Quality Assurance
- Adhere to HIPAA and billing compliance standards.
- Stay informed about state-specific OON regulations and emerging payer practices.
- Handle sensitive information in a confidential manner and maintain strong customer relations.
Knowledge, Skills, and Abilities:
- Proficiency in using accounting software, Microsoft Excel, and Outlook and experience with medical billing software and clearinghouses.
- Strong background in appeals writing or payer dispute resolution.
- Experience with out of network billing (breast reconstructive surgery, spinal surgery, neurosurgery, orthopedics, etc.)
- High attention to detail, persistence, and the ability to manage high volumes of claims.
- Effective organization and time management skills to handle multiple tasks and meet deadlines.
- Strong analytical skills in accounts receivable and general accounting.
- Excellent negotiation, communication, and documentation skills.
- Ability to analyze billing data, identify discrepancies, and resolve issues.
- Ability to analyze financial data and identify trends or discrepancies.
- Ability to read and analyze EOBs, remittance advice, and plan documents.
- Strong understanding of UCR rates, payer negotiation tactics, and OON benefit structures.
- Consistently maintain a professional demeanor.
- Effectively work independently, as well as in a team environment.
· Education and Experience:
- Associate degree or equivalent work experience.
- 2+ years of experience in an accounts receivable function.
- 1–3 years of experience in out-of-network medical billing, collections, or payer follow-up, A PLUS.
Salary and Benefits:
- Starting at $27 per 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:
- Accounts Receivable: 2 years (Preferred)
- Out-of-Network Medical Billing: 1 year (Preferred)
- Medical collection: 1 year (Preferred)
- Medical Claims Analysis and Collections: 1 year (Required)
Ability to Commute:
- Red Bank, NJ 07701 (Required)
Work Location: In person
