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 Specialist focuses on investigating, diagnosing, and reversing rejected or underpaid healthcare insurance claims. This position ensures organizational revenue is secured by coordinating with insurance payers, internal departments, and clinicians to guarantee accurate reimbursement while complying with regulatory guidelines and payer policies.

Key Responsibilities

• Evaluate and diagnose the causes of rejected, unpaid, or short-paid healthcare claims.
• Correct billing errors, adjust diagnostic/procedural codes, attach necessary documentation, and submit corrected claims within strict payer deadlines.
• Engage in proactive follow-ups with insurance companies to expedite the resolution of pending denials and secure outstanding revenue.
• Initiate direct contact with insurance adjudicators to verify claim status, clarify disputes, and reconcile payment discrepancies.
• Thoroughly document all administrative actions, payer interactions, and resolution outcomes within practice management and billing systems.
• Identify systemic denial trends, recurring errors, or anomalies among insurance carriers, medical specialties, or coding classifications.
• Collaborate with coding experts, clinical staff, and billing personnel to implement workflow changes, staff training, and documentation improvements to reduce future claim rejections.
• Support the Appeals Teams by monitoring the progress of submitted appeals, ensuring absolute compliance with complex payer timelines and regulatory requirements.
• Ensure all amended claims and resubmissions comply precisely with state, federal, and payer-specific compliance mandates.
• Stay updated on evolving insurance policies, national coding updates (CPT, HCPCS, ICD-10), and revenue cycle best practices.
• Compile comprehensive denial analytics, assess reimbursement trends, and provide actionable insights to management.
• Track critical revenue cycle metrics, including overall denial percentages, appeal success rates, and days in accounts receivable.

Qualifications

• 2–4 years of experience in medical billing, claims processing, or denial management in a healthcare or payer setting.
• Strong understanding of insurance payer rules for both commercial and government payers.
• Excellent knowledge of CPT/HCPCS and ICD-10 coding.
• Proficiency with EMR/EHR systems, clearinghouses, and billing software.
• CPC, CPB, or another AAPC/AHIMA certification preferred.
• Experience with high-volume claims environments is advantageous.

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 commitment to our candidates is to continuously offer benefits that align with the needs of our expanding workforce. Eligible team members will be able to access and contribute to these benefits after meeting specific criteria. We welcome inquiries regarding our comprehensive benefits offerings and are proud to support our employees' well-being. Please note that eligibility and application to certain benefits are based on plan availability and state-specific regulations.

^*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.