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 Appeals Representative responsible for analyzing payer downcodes, determining appeal strategies, executing claim corrections, crafting technical appeals, and identifying denial trends. The role involves ensuring compliance, accuracy, and adherence to regulations within the healthcare billing process.
Key Responsibilities
- Analyze Payer Downcodes: Review and audit high-level E/M claims that have been downcoded or denied after a level-1 appeal.
- Determine Appeal Strategy: Audit provider clinical notes to ensure billing code compliance with AMA/CMS documentation guidelines.
- Execute Claim Corrections: Correct billing codes in Epic for unsupported documentation to ensure compliant billing.
- Craft Technical Appeals: Draft robust appeal rationales citing guidelines or criteria to contest payer downcodes.
- Identify Denials Trends: Track systemic downcoding trends and recommend proactive education or system adjustments.
- Maintain Accuracy Standards: Ensure all adjustments and appeals comply with regulations and accuracy standards.
Qualifications
- Expert-level understanding of E/M coding guidelines and updated Medical Decision Making framework.
- Capable of utilizing own equipment and encoder.
- Minimum of 2 years of experience dedicated to Physician Billing (PB) / Professional Fee coding.
Experience
- Minimum of 2 years in Physician Billing / Professional Fee coding.
- Experience with Epic EMR systems is highly preferred.
Skills
- Technical: Proficiency in Epic systems, coding software.
- Soft Skills: Strong analytical abilities, attention to detail, excellent communication skills.
Additional Requirements
Full-time 8-hour day flex start time with training starting at 8 am for the first two weeks.
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 equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability status, protected veteran status, or any other characteristic protected by law.
*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.
