Appeals Specialist I

JOB DESCRIPTION

At ROMTech, we are transforming rehabilitation through innovative technology and exceptional patient support. We are committed to helping patients achieve better outcomes through Clinician guided at-home rehab while delivering an outstanding experience throughout their recovery journey.

ROMTech is a medical technology company that has created and patented a revolutionary medical device and telemedical platform which delivers in-home rehabilitative care. Our disruptive technology has proven to yield faster recoveries and better outcomes with unmatched patient compliance. We began in orthopedics and have entered scale-up of our orthopedic business. We are now leveraging our core technology, infrastructure, and first mover position to enter cardiology, followed by other adjacent markets. Having created this new lane, we have a unique opportunity to serve as the global leader in the business, technology, and science of recovery, and to bring life-changing help to many millions of people.

Position Title: Appeals Specialist
Department: Revenue Cycle Management
Reports To: Appeals Manager
Location / Work Environment: Office Environment
Worker Classification: W-2 Employee
FLSA Status: Non-Exempt
Job Level: Standard

The Appeals Specialist plays a critical role in supporting ROMTech's revenue cycle by ensuring timely, accurate, and compliant resolution of denied insurance claims. This role directly contributes to the organization's financial performance and patient access to care by optimizing reimbursement outcomes and maintaining adherence to payer guidelines. The position supports the delivery of Clinician guided at-home rehab by ensuring claims related to ROMTech devices are appropriately reviewed, appealed, and processed.

• Review and analyze denied insurance claims to determine appropriate appeal strategies.
• Prepare, submit, and track appeals in accordance with payer-specific requirements and established timelines.
• Collaborate cross-functionally with billing, coding, and clinical teams to obtain supporting documentation for appeals.
• Interpret Explanation of Benefits (EOBs), payer policies, and reimbursement guidelines to support appeal decision-making.
• Monitor appeal status and proactively follow up on unresolved, pending, or outstanding claims.
• Maintain accurate and detailed records of appeals activity within designated system platforms.
• Ensure compliance with payer regulations, internal policies, HIPAA requirements, and healthcare reimbursement standards.
• Prioritize and manage multiple appeals cases while meeting established productivity and quality expectations.
• Research payer requirements and identify opportunities to improve reimbursement outcomes.
• Communicate effectively with insurance carriers and internal stakeholders regarding appeal status and resolution.

• Support process improvement initiatives within the Revenue Cycle Management department.
• Assist with reporting, audits, and reconciliation activities related to claims and appeals.
• Provide general administrative support to the Revenue Cycle Management team as needed.
• Participate in departmental meetings, training sessions, and professional development activities.
• Performs other related duties as assigned to support operational and business needs.

JOB QUALIFICATIONS

• 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.

• 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 medical billing, claims processing, insurance follow-up, or revenue cycle management.

• 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.

• None.

• High school diploma or equivalent.

• None.

• Certified Professional Coder (CPC).
• Certified Coding Specialist (CCS).
• Certified Revenue Cycle Representative (CRC) or similar coding, billing, or revenue cycle certification.

The following describes the physical demands and work environment characteristics required to perform the essential functions of this position. These requirements are representative of those an employee may encounter while performing the job and are not intended to be an exhaustive list. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.

• Ability to sit at a computer terminal for an extended period.
• Moderate noise (i.e., phone calls, online meetings, computer audio).
• While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard.
• Specific vision abilities required by this job include close vision requirements due to computer work.
• Regular, predictable attendance is required.
• Must be able to communicate clearly and professionally in both verbal and written formats.
• Must be able to engage in active listening and express ideas effectively in person, by phone, and via virtual meetings.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Reasonable accommodation requests must be made in writing by emailing [email protected].