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 meticulous Healthcare Appeals Specialist to join their corporate headquarters team. The successful candidate will oversee the end-to-end administration of disputed insurance claims, executing strategic solutions to maximize legitimate provider reimbursement. This is a full-time, on-site role operating during standard business hours.
Key Responsibilities
- Evaluate rejected insurance claims to diagnose root causes and formulate targeted appellate strategies.
- Draft, assemble, and submit comprehensive formal appeal packages backed by robust clinical and administrative documentation.
- Routinely monitor outstanding appeals, maintaining rigorous tracking logs of their current status and progress.
- Serve as the central point of contact to clarify claim statuses and resolve disputes with insurance carriers, clinical personnel, and patients.
- Archive precise, audit-ready documentation detailing all appeal submissions, correspondence, and operational actions.
- Evaluate the results of resolved appeals to identify systemic payment trends and recommend long-term improvements for the billing cycle.
- Proactively monitor changing insurance policies, governmental healthcare mandates, and regional payer regulations to maintain absolute compliance.
Qualifications
- 2+ years experience in medical billing, claims processing or appeals management (Provider or professional side - not facility).
- Strong knowledge of CPT and ICD-10 codes.
- Medical terminology knowledge.
- Familiarity with insurance policies on commercial and government payers.
- Bachelor's degree in healthcare administration or related field.
- Anesthesia or related specialty experience.
Skills
- Strong knowledge of CPT and ICD-10 codes.
- Medical terminology knowledge.
- Familiarity with insurance policies on commercial and government payers.
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.
