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 Patient Account Representative to manage insurance claim services, status, appeals, and data, ensuring timely and complete reimbursement for services rendered.

Key Responsibilities

• Partner with diverse third-party payer landscape, including major health insurers, to ensure timely and complete reimbursement.
• Coordinate and process payments from carriers and troubleshoot adjudication issues.
• Properly document claim files and request clinical records.
• Review medical bills and A/R reports.
• Engage in regular telephone and portal-based communications with payers to resolve local coverage determination (LCD) issues.
• Monitor the status of claims pending payment via various insurance portals (e.g., Availity, Optum).
• Correct and resubmit claims as necessary, ensuring compliance with billing guidelines.
• Identify payer trends, such as delays in Medicaid processing or systemic issues with commercial payers, and notify management of negative shifts.
• Process timely appeals of denied, rejected, or delinquent claims in accordance with "Clean Claim" laws and payer-specific deadlines.
• Navigate complex denials for medical necessity, bundled codes, and inappropriate reimbursement relative to contracted fee schedules.
• Resolve disputes through direct interaction with insurance carriers, hospitals, and specialty units (e.g., dialysis or oncology) to ensure the Practice is reimbursed for the full value of services rendered.
• Maintain accurate records, including preparing and reviewing financial reports.
• Update data discrepancies identified in systems and ensure all PHI (Protected Health Information) is handled in accordance with both Federal HIPAA and state privacy statutes.
• Accurately document all work activities to ensure a clear audit trail for the Practice’s financial success.

Qualifications

• Knowledge of insurance guidelines and requirements, medical documentation, billing, and third-party reimbursement strongly preferred.
• Ability to solve problems and answer questions quickly.

Experience

• 3+ years of experience in a medical billing or health insurance role preferred.
• Experience working in a large physician practice (50+ doctors).

Skills

• Proficiency with EPIC experience.
• Ability to work 200+ claims a week.
• Ability to handle a larger volume of work.

Additional Requirements

• This is an on-site position.
• Standard schedule is Monday-Friday, 8:30 AM - 5:00 PM.
• Potential to switch to a 4x10 hour day schedule after demonstrating performance, typically post-conversion.

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.