JOB DESCRIPTION

Approved Opening Statement

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

Job Purpose

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.

Key Responsibilities

Essential Duties

• 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.

Other Functions

• 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.