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 Denials Specialist to manage insurance appeals and claim denials. The primary responsibilities include reviewing and analyzing claim denials, performing necessary appeals, communicating with payers, and recommending process improvements to prevent future denials.

Key Responsibilities

• Review and analyze claim denials and perform necessary appeals for reimbursement.
• Research denied claims and determine appropriate appeal steps.
• Communicate with payers to resubmit denied, underpaid, or inaccurately processed claims.
• Track and document denials by payer, visit type, and denial category.
• Identify trends in recurring denials and recommend process improvements or system edits.
• Work with payers to understand denial reasons and implement measures to prevent future denials.
• Process patient refunds promptly upon insurance payment or EOB receipt.
• Communicate effectively with managers, physicians, clinical, and support staff.
• Maintain confidentiality of sensitive patient and financial information.
• Collaborate with billing staff to resolve denial issues related to provider credentialing.
• Support special projects and cross-train to cover billing department tasks as needed.
• Stay current with state and federal regulations and payer updates.
• Continuously seek ways to improve AR processes and departmental efficiency.
• Participate in emergency response and safety programs as required.

Qualifications

• High school diploma
• Extensive knowledge of third party billing and payment methodologies required
• 2 years’ experience preferred in managing insurance appeals and denials
• Experience with ECW and FQHC preferred

Skills

• Analytical and problem-solving skills
• Effective communication and team collaboration

Additional Requirements

The position requires full-time presence on-site, from Monday to Friday, 8:00 AM to 5:00 PM with a 1-hour lunch break.

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.

Required Employment / Compliance Language

Our client is an equal opportunity employer. They value diversity and are committed to creating an inclusive environment for all employees.

^*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.