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 Insurance Collection Specialist responsible for managing and resolving outstanding insurance claims. The role involves communication with insurance companies, analyzing claims and payments, and effectively ensuring timely collections.
Key Responsibilities
Collections & Accounts Receivable
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Proactively manage an assigned aging portfolio of insurance claims across commercial, Medicare, Medicaid, and managed care payers.
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Conduct timely, assertive follow-ups on unpaid, denied, or underpaid claims via telephone, payer portals, and written correspondence.
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Identify and resolve claim edits, rejections, and denials related to prior authorization, eligibility, coding, or medical necessity.
Denial Management & Appeals
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Analyze root causes of complex denials and underpayments; prepare and submit effective first-level and second-level appeals with supporting clinical and coding documentation.
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Partner with internal pharmacy teams to obtain necessary medical records, physician attestations, or supporting documentation for appeals.
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Track appeal activity within the EMR system and escalate high-dollar or complex denials to leadership as needed.
Payer & Reimbursement Expertise
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Navigate both medical benefit (Part B, commercial medical) and pharmacy benefit (Part D, specialty PBM) claim pathways.
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Utilize working knowledge of HCPCS, NDC, modifiers, and revenue codes applicable to infusion therapy and specialty pharmacy.
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Stay informed on payer policy updates, billing guidelines, and CMS regulations impacting reimbursement.
Documentation & Compliance
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Maintain accurate, thorough notes in the EMR system for all account actions.
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Spot systemic billing trends or issues and communicate them to leadership to drive process improvements.
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Strictly adhere to HIPAA regulations and federal/state compliance standards regarding protected health information (PHI).
Qualifications & Requirements
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Experience: 2–3+ years of experience in healthcare insurance collections or accounts receivable.
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Specialized Knowledge: Direct experience in home infusion, specialty pharmacy, or Immunoglobulin (IG) therapy billing/collections is strongly preferred.
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Payer Expertise: Demonstrated ability to work with major payers including Medicare, Medicaid, PBMs, and commercial insurance.
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Billing Systems: Familiarity with pharmacy/medical billing platforms such as CareTend, CPR+, or Waystar.
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Technical Skills: Proficiency in Microsoft Office Suite, particularly Microsoft Excel.
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Key Attributes: High resilience, exceptional organizational skills, ability to manage high-volume workloads, and a dedicated, investigative approach to resolving unpaid claims.
Skills
- Proficient in insurance claim procedures and documentation.
- Excellent communication and negotiation skills.
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.
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.
