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 Denials Follow-Up Specialist – Provider Enrollment. This role involves investigating, resolving, and preventing insurance claim denials related to provider enrollment, credentialing, and payer participation status. The specialist will support revenue cycle operations by identifying enrollment-related claim issues, coordinating with internal teams, and working with insurance payers to resolve outstanding claims and secure appropriate reimbursement. The ideal candidate will possess a strong understanding of healthcare claims processing, insurance payer requirements, provider enrollment workflows, and denial management, and will be detail-oriented, analytical, and capable of managing a high-volume workload while meeting productivity, quality, and financial performance goals.

Key Responsibilities

• Review and analyze denied, rejected, and unpaid healthcare claims related to provider enrollment, credentialing, payer registration, and network participation issues.
• Investigate denial reasons, including providers not enrolled or credentialed with the payer, enrollment effective-date discrepancies, missing or incomplete provider records, incorrect provider identifiers, and billing provider or rendering provider enrollment mismatches.
• Perform timely claim follow-up with commercial insurance payers, Medicare, Medicaid, and other applicable reimbursement entities to determine the cause of denials and identify resolution requirements.
• Verify provider enrollment status, effective dates, payer participation, National Provider Identifier (NPI), and other relevant provider information to support accurate claim adjudication.
• Collaborate with provider enrollment, credentialing, billing, coding, contracting, and other revenue cycle teams to resolve enrollment-related barriers to reimbursement.
• Identify claims requiring enrollment updates, retroactive effective-date corrections, payer record modifications, or additional documentation.
• Submit corrected claims, reconsiderations, appeals, and supporting documentation as appropriate and within payer-specific filing and appeal deadlines.
• Maintain accurate and detailed documentation of denial findings, payer communications, claim actions, resolution plans, and follow-up activities in designated systems.
• Monitor assigned accounts and outstanding claims to ensure timely follow-up, appropriate escalation, and resolution in accordance with established workflows.
• Identify recurring denial trends, payer processing issues, and systemic enrollment gaps that may contribute to delayed or lost reimbursement.
• Escalate unresolved enrollment issues, aging claims, timely filing risks, and high-dollar accounts to the appropriate internal teams or leadership.
• Support denial prevention initiatives by communicating recurring issues and recommending process improvements to reduce avoidable denials and rework.
• Meet established productivity, quality, turnaround time, and financial recovery expectations while maintaining compliance with applicable policies and regulations.

Experience

• 3+ years in AR experience.
• Experience with Medicaid HMO.
• Experience with Emergency Medicine and/or hospitalist medicine specialties.
• Experience with working claims that are denied based on provider enrollment criteria (taxonomy codes incorrect, NPI, timely filing, carrier IDs, provider effective dates etc).

Skills

• Athena (preferred).
• QGenda (credentialing platform) (preferred).

Additional Requirements

• Schedule: Monday - Thursday onsite, Fridays remote.
• Flexible start time between 6am-8:30am, with end time no later than 5pm (40 hour work week).

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.