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 Healthcare Policy & Appeals Coding Specialist for a full-time contract role. You will be part of a collaborative team responsible for maintaining clinical coding policies and updating claims editing logic. The primary focus will be on payment integrity and provider appeals, including auditing outpatient claims and reviewing medical records.
Key Responsibilities
- Evaluate Appeals: Review contested provider and facility claims to ensure alignment with correct coding logic.
- Maintain Policies: Assist in writing, reviewing, and updating internal coding policies and claims-editing system configurations.
- Provide Clear Rationale: Draft clear, professional written justifications for appeal decisions, citing official industry sources.
- Act as a Subject Matter Expert: Serve as the go-to coding resource for internal teams, collaborating with medical directors, claims operations, and compliance.
Qualifications
- 7–10+ years of coding experience across a variety of medical specialties.
- Strong expertise in CPT and HCPCS code sets, focusing on outpatient coding.
- A proven track record working on the clinical/delivery side of healthcare, with experience in chart extraction.
- Active CPC, CCS, or RHIA credential (RHIA candidates must have extensive hands-on coding experience).
Experience
- 7–10+ years of experience in coding.
- Specific experience in outpatient & surgical coding.
Skills
- Technical proficiency in CPT and HCPCS code sets.
- Excellent communication and the ability to work collaboratively in a team environment.
Additional Requirements
Full-time position with flexible core hours across all time zones once training is complete.
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 complies with all applicable employment and compliance regulations, ensuring a safe and supportive work environment.
*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.
