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 experienced and detail-oriented Out-of-Network (OON) Accounts Receivable Representative to join their revenue cycle team. In this role, you will be responsible for managing, tracking, and resolving outstanding out-of-network medical claims. You will serve as an expert in navigating commercial payor policies, state and federal out-of-network regulations (including the No Surprises Act), and patient financial responsibility to ensure maximum and timely reimbursement.

Key Responsibilities

• Claim Follow-Up & Resolution: Actively follow up on unpaid, delayed, or denied out-of-network claims with commercial payors via phone, web portals, and written correspondence.
• Denials & Appeals Management: Identify root causes for claim denials, partial payments, or low reimbursements. Draft and submit formal administrative and clinical appeals supported by appropriate medical documentation.
• Out-of-Network Price Negotiation: Engage with payor single-case agreement (SCA) teams, third-party repricing vendors (e.g., MultiPlan, Zelis), and ERISA plan administrators to negotiate fair reimbursement rates and settle disputed claims.
• Regulatory Compliance: Stay up to date on state and federal surprise billing laws, independent dispute resolution (IDR) processes, and payor-specific OON policies.
• Patient Financial Counseling: Work with patients to explain out-of-network coverage, deductible responsibility, co-insurance, and payment options while ensuring compliance with balance billing regulations.
• Reconciliation & Auditing: Audit Explanation of Benefits (EOBs) and Remittance Advices (RAs) to ensure payors pay according to usual, customary, and reasonable (UCR) rates or contracted out-of-network allowances.
• Reporting & Escalations: Maintain accurate notes in the medical billing system, track performance metrics (e.g., Days in AR, collection rates), and escalate high-value or complex payor trends to leadership.

Qualifications

• Minimum of 2–4 years of experience in healthcare Accounts Receivable or medical billing, with at least 1–2 years strictly focused on Out-of-Network billing.
• Deep understanding of the No Surprises Act, Independent Dispute Resolution (IDR) portal workflows, ERISA guidelines, and state-level balance billing restrictions.
• Proficiency with Electronic Health Record (EHR) and RCM software (e.g., Epic, eClinicalWorks, AdvancedMD, Kareo, or similar).

Skills

• Strong negotiation, analytical, and problem-solving abilities; excellent written communication for drafting persuasive appeal letters.
• Broad familiarity with major commercial carriers (BCBS, Aetna, Cigna, UHC) and third-party repricers.

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

^*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.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*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.