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

Job Summary

As a Claims Advocate, you will be part of a vibrant team of high-performing and highly engaged professionals that work to ensure a quality patient experience within our service level agreements. The role serves as a liaison between plan members, providers, and health insurance companies to get claims issues resolved, handling all communication, paperwork, and negotiations with a health insurance carrier or provider on behalf of the plan member.

Key Responsibilities

• Provide effective and timely customer service for members, providers, insurers, and clients regarding health care claims.
• Ensure timely follow-up on requests for accounts to be reviewed.
• Organize health insurance paperwork and medical record documentation.
• Demonstrate knowledge of proprietary software and other required technology (Google apps, etc).
• Negotiate with providers on plan member balances and challenge denials of claims by the insurance company.
• Communicate with medical offices, hospitals, laboratories, etc. to obtain relevant records for the patient's case.
• Contact providers and insurance companies to resolve claim concerns.
• Assist with understanding of explanation of benefits (EOBs) and help members resolve their errors.
• Analyze and identify trends and patterns related to member billing complaints.
• Collaborate with peers and management across functions, adapting operational processes to meet evolving business requirements.
• Maintain a friendly phone demeanor while demonstrating persuasion in overcoming objections in a fast-paced dynamic environment with competing priorities.
• Model a culture reflective of our Core Company Values and gain a thorough understanding of the Patient Care Team policies and processes.

Qualifications

• 1+ years of claims experience required within hospital or large provider groups (10+ providers).
• 2+ years of Healthcare Collections and Accounts Receivable.
• Passion for providing support with highly effective communication, problem resolution, and organizational skills.
• Demonstrated ability to meet goals in a rapidly changing environment.
• Excellent data and overall analytical skills with a proven track record of driving measurable efficiency results.
• Medical billing/coding certification (CPC) beneficial, but not required.
• College degree preferred (additional experience in lieu of college degree will be considered).

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.