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 Coding Denials Specialist to perform advanced level work related to coding denials management. The individual will be responsible for resolving coding claim edits and denials, as well as assisting in the development and implementation of solutions to minimize avoidable denials.

Key Responsibilities

• Research payer denials related to coding, documentation, and billing resulting in denials and payment delays.
• Conduct comprehensive reviews of claim denials and associated records to determine corrective action.
• Write and submit professionally written appeals using clinical documentation and payer policies.
• Collaborate with authorization teams to obtain necessary retro-authorizations.
• Identify and escalate denial patterns to management for resolution.
• Recommend changes to work queues to improve efficiency and reduce denials.
• Review payer communications to identify risk for reimbursement loss and escalate issues appropriately.
• Identify opportunities for process improvement and participate in initiatives.

Qualifications

• Knowledge of payer policies and claims requirements.
• Advanced knowledge of CPT, ICD-10 coding, and payer/governmental policies.
• Proficiency with EMRs (EPIC) and Microsoft Office.
• Ability to manage multiple tasks efficiently with a focus on continuous process improvement.
• Effective communication and interpersonal skills, with a strong problem-solving ability.

Experience

• Five (5) years of experience in a healthcare setting, working in coding and/or reimbursement follow-up.
• Preferred: Five+ (5+) years of experience in professional revenue cycle operations for large, multispecialty group practices or academic medical centers.

Education

• Minimum: High school diploma.
• Preferred: Bachelor’s degree in business, healthcare management, or related fields.

Skills

• Technical: Proficiency in EMRs and Microsoft Office.
• Soft Skills: Effective communication, ability to handle changes in duties and work volume, teamwork, and problem-solving capabilities.

Additional Requirements

• Certified professional coder certification (CCS-P, CPC, CCA) and/or health information management credential (RHIT or RHIA).

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).

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.

^*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. 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.