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 Denial Management Specialist who will be responsible for investigating, analyzing, and disputing complex medical claim denials and rejections. This role involves preparing and submitting comprehensive written appeals and supporting documentation for commercial and Medi-Cal claims, ensuring timely filing and compliance with regulations.

Key Responsibilities

• Manage denials and appeals by investigating claim denials and submitting appeals for commercial and Medi-Cal claims.
• Comply with California Billing & Payor regulations, demonstrating knowledge of Medi-Cal regulations and commercial payer rules.
• Collaborate with Independent Physician Associations (IPAs) and Managed Care Organizations (MCOs) to resolve financial disputes.
• Utilize NextGen Practice Management software for accounts receivable monitoring and denial tracking.
• Perform daily follow-up on outstanding accounts receivable balances, engaging with payers to expedite payment.
• Conduct root cause analysis to identify denial trends and implement process improvements.
• Maintain accurate records in compliance with HIPAA and state healthcare regulations.

Qualifications

• Proficiency with NextGen software.
• Strong understanding of California Medi-Cal (Medicaid) and commercial claims.
• Experience working with IPA's and MCOs.
• Strong experience in appeals and denials management.

Experience

• 5+ years of experience in accounts receivable and denial management.

Skills

• NextGen software proficiency.
• Strong analytical and problem-solving skills.

Additional Requirements

• Able to work in the Central Time Zone, although the position can be located anywhere.

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

Medix is committed to providing equal employment opportunities and fostering a workplace free of discrimination. All qualified applicants will receive consideration for employment without regard to any characteristic protected by law.

^*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.