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

Job Summary

The Denials Optimization Lead is responsible for driving strategic initiatives aimed at minimizing claim denials and maximizing revenue recovery. This role combines data-driven analysis with cross-functional leadership to identify systemic vulnerabilities and implement preventative solutions. The successful candidate will serve as a liaison between Patient Access, Coding, and Billing, utilizing Epic Resolute to optimize appeal success rates and ensure seamless, system-wide financial performance.

Key Responsibilities

• Develop and manage denial reporting dashboards using Epic Cogito, Radar, and Reporting Workbench.
• Transform CARC/RARC data into actionable insights and conduct deep-dive root cause analyses.
• Audit the CDM (Charge Description Master) to eliminate denials resulting from CPT/HCPCS mismatches.
• Design prevention initiatives across the revenue cycle to enhance process efficiency.
• Collaborate with Patient Access and Coding/CDI to reinforce eligibility and authorization workflows.
• Develop sophisticated pre-bill claim edits and automated prevention workflows.
• Create standardized appeal templates and workflows for improved recovery rates.
• Monitor appeal lifecycles and collaborate with Payer Contracting to ensure contract compliance.
• Optimize Epic Resolute work queues and lead cross-departmental task forces for denial management.

Qualifications

• 3–5+ years of experience in healthcare revenue cycle management, with a history of reducing denial rates.
• Hands-on experience with Epic Resolute (HB/PB); familiarity with Denials Pulse preferred.
• Proficiency in using analytics tools like Excel, Tableau, or Epic Cogito for data analysis.
• Comprehensive knowledge of current payer policies and CMS guidelines.
• Ability to perform complex root-cause analysis and improve system-wide processes.
• Exceptional communication skills for leading collaborative initiatives across departments.
• Advanced understanding of the appeals process, including drafting high-conversion templates.

Preferred Skills

• HFMA CRCR certification.
• Epic Certifications in Resolute Hospital Billing, Professional Billing, or Cogito Reporting.
• Certified in Lean Six Sigma or a similar process improvement methodology.

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.