You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a detail-oriented and experienced Out of Network Accounts Receivable (A/R) Representative to join their healthcare finance team. The ideal candidate will manage and resolve out-of-network insurance claims and ensure timely and accurate reimbursement. This role requires a strong understanding of medical billing, coding, and insurance procedures, along with excellent analytical and communication skills.

Key Responsibilities

• Review, submit, and follow up on out-of-network insurance claims to ensure timely payment.
• Investigate and resolve claim denials and discrepancies by working with insurance companies, patients, and internal departments.
• Appeal denied or underpaid claims by providing necessary documentation and evidence.
• Reconcile payments and adjustments, ensuring accuracy in patient accounts and financial records.
• Monitor accounts receivable aging reports and take proactive measures to collect outstanding balances.
• Perform audits on patient accounts to identify and rectify errors.
• Communicate with insurance companies to verify coverage, obtain authorizations, and clarify payment policies.
• Serve as a point of contact for patients regarding billing inquiries, providing clear and accurate information.
• Collaborate with internal departments, including billing, coding, and patient services, to streamline processes and improve reimbursement rates.
• Maintain accurate and detailed records of all claims, payments, and communications with insurance companies.
• Generate regular reports on account statuses, collection activities, and financial performance metrics.
• Ensure compliance with federal, state, and payer-specific billing regulations and guidelines.

Qualifications

• High school diploma or equivalent; associate's degree in healthcare administration, finance, or related field preferred.
• Minimum of 2 years of experience in medical billing and accounts receivable, specifically with out-of-network claims.
• Strong knowledge of medical terminology, billing codes (CPT, ICD-10), and insurance procedures.
• Proficiency in using billing software and electronic health records (EHR) systems.
• Excellent analytical, problem-solving, and organizational skills.
• Strong verbal and written communication skills.
• Ability to work independently and as part of a team in a fast-paced environment.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.