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 an Insurance Collection Specialist to join their team. Results-driven Insurance Collections Specialist with 3+ years of experience managing complex healthcare claims across commercial, Medicare, Medicaid, and managed care payers. Strong expertise in specialty pharmacy and home infusion billing, including IG therapies, prior authorizations, and payer-specific adjudication processes. Proven ability to resolve denials, reduce AR aging, and optimize reimbursement through detailed claim analysis and proactive follow-up.
Professional Experience
- Managed a high-volume aging portfolio of insurance claims, ensuring timely follow-up and resolution across commercial, Medicare, Medicaid, and managed care payers
- Performed outbound calls and utilized payer portals to resolve unpaid, denied, and underpaid claims
- Investigated and corrected claim issues related to eligibility, authorization, coding, and medical necessity
- Submitted corrected claims and supporting documentation to ensure accurate reimbursement
Denial Management & Appeals
- Analyzed root causes of denials and underpayments; prepared and submitted first- and second-level appeals
- Coordinated with clinical and pharmacy teams to obtain medical records, physician attestations, and supporting documentation
- Tracked and documented all appeal activity in EMR systems; escalated complex or high-dollar accounts as appropriate
- Improved reimbursement outcomes by identifying trends and implementing corrective actions
Payer & Claims Expertise
- Applied knowledge of HCPCS, NDC, and revenue codes specific to infusion therapy and specialty pharmacy billing
- Navigated both medical (Part B/commercial) and pharmacy (Part D/PBM) benefit structures
- Interpreted EOBs and remittance advice to identify discrepancies and drive resolution
- Maintained up-to-date knowledge of payer policies, CMS guidelines, and reimbursement regulations
Documentation & Reporting
- Maintained accurate and detailed account notes within EMR systems for all collection activities
- Identified recurring billing and process issues; communicated findings to leadership to support operational improvements
- Assisted with reporting on AR trends, denial patterns, and collection performance
Compliance & Quality
- Ensured full compliance with HIPAA regulations and all applicable federal and state guidelines
- Maintained high standards of professionalism, confidentiality, and communication in all interactions
Skills
- Insurance Collections & Accounts Receivable
- Denial Management & Appeals
- Specialty Pharmacy & Home Infusion Billing
- IG Therapy Claims & Coverage Criteria
- Prior Authorization & Claims Adjudication
- HCPCS, NDC, Revenue Codes
- Medicare, Medicaid, Commercial & PBM Payers
- EOB & Remittance Analysis
- EMR & Billing Systems (e.g., CareTend, CPR+, Waystar)
- Microsoft Excel & Reporting
- High-Volume Workload Management
- Cross-Functional Collaboration
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.
