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 highly skilled Medical Insurance Claims Specialist to ensure the accuracy of surgical claims across Medicare, Managed Care, and private insurance. This role involves meticulous specialty-specific coding review, end-to-end appeals management without external supervision, and proactive revenue recovery through diligent monitoring and direct communication with insurance carriers. The specialist will also track denial patterns to provide actionable insights and improve the "clean claim" rate.

Key Responsibilities

• Complex Claims Oversight: Ensure the accuracy of surgical claims for Medicare, Managed Care, and private insurance, verifying that all documentation supports the level of service billed.
• Specialty-Specific Coding Review: Analyze medical records to ensure proper application of ICD-10 and CPT codes, with a heavy focus on surgical modifiers and global period regulations.
• End-to-End Appeals Management: Take full ownership of the appeals process. This includes researching denials, drafting persuasive clinical appeals, and following through to resolution without external supervision.
• Revenue Recovery: Proactively monitor aging reports to identify underpayments and denials. Communicate directly with insurance carriers to resolve payment delays and minimize adjustments.
• Trend Analysis: Track and report on denial patterns to provide actionable insights that prevent future revenue leakage and improve the "clean claim" rate.

Qualifications

• Specialist in complex appeals and payor escalations.
• Expert at resolving eligibility, COB, and demographic errors.
• Proficient in ICD-10 and CPT modifiers for specialty medicine (Dermatology).
• Specialty or surgery billing preferred.

Experience

• Minimum 2 years in medical billing.

Skills

• Revenue Cycle Management
• Denial Prevention
• Specialty Coding (ICD-10, CPT modifiers for specialty medicine/Dermatology)
• Advanced proficiency in ModMed (EMA), PM systems, and Google Suite.

Education

• Degree or certification preferred.

Additional Requirements

• Work schedule: M-F: 8-5; F 7:30-4:30 (onsite)

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, 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.