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 dedicated Recertification Specialist who will be responsible for obtaining prior authorizations and verifying insurance coverage for medical services and procedures. The role aims to secure all necessary approvals before services are provided, thereby minimizing claim denials and supporting efficient revenue cycle operations while ensuring a positive patient experience.
Key Responsibilities
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Authorization Procurement: Direct the end-to-end prior authorization process for medical procedures and tests, ensuring all required approvals are secured from insurance carriers prior to the date of service.
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Coverage Verification: Execute detailed insurance eligibility audits and benefit reviews to confirm patient coverage levels and identify specific payer requirements.
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Clinical Documentation Review: Analyze physician orders and medical records to ensure clinical necessity is clearly established and documented for submission to insurance portals.
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Proactive Case Management: Monitor the status of pending authorizations via payer portals and phone follow-ups, proactively resolving delays to ensure timely patient access to care.
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Cross-Functional Collaboration: Serve as a vital liaison between clinical, scheduling, and billing departments to communicate approval statuses and resolve complex authorization issues or denials.
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Revenue Cycle Integrity: Maintain meticulous records of all precertification activities within the EHR/Practice Management system while staying current on evolving payer policies and regulatory changes.
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Authorization Procurement: Direct the end-to-end prior authorization process for medical procedures and tests, ensuring all required approvals are secured from insurance carriers prior to the date of service.
-
Coverage Verification: Execute detailed insurance eligibility audits and benefit reviews to confirm patient coverage levels and identify specific payer requirements.
-
Clinical Documentation Review: Analyze physician orders and medical records to ensure clinical necessity is clearly established and documented for submission to insurance portals.
-
Proactive Case Management: Monitor the status of pending authorizations via payer portals and phone follow-ups, proactively resolving delays to ensure timely patient access to care.
-
Cross-Functional Collaboration: Serve as a vital liaison between clinical, scheduling, and billing departments to communicate approval statuses and resolve complex authorization issues or denials.
-
Revenue Cycle Integrity: Maintain meticulous records of all precertification activities within the EHR/Practice Management system while staying current on evolving payer policies and regulatory changes.
Skills
- Proficiency in securing prior authorizations and verifying insurance details.
- Strong communication skills, including the ability to interact with clinical staff and patients.
- Ability to maintain accurate documentation and resolve authorization-related issues.
- Capability to stay informed about payer policies and regulatory changes.
- Collaborative mindset for effective coordination with various departments.
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
Medix is an
*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.
