You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Company Information
Our client company
Job Summary
Our client is seeking a Dispute Resolution Specialist, a highly organized, process-driven paralegal with a strong background in health insurance or medical billing to manage and administer out-of-network health insurance claim payment disputes. In this role, you will lead their efforts to resolve underpaid medical claims by guiding them through the federal Independent Dispute Resolution (IDR) process established by the No Surprises Act.
Key Responsibilities
- Evaluate incoming denied or underpaid medical claims to determine if they qualify for the federal No Surprises Act process.
- Gather, interpret, and compile all necessary case documentation, including medical records, billing data, and Explanations of Benefits (EOBs).
- Actively track and monitor strict statutory deadlines to ensure no filing windows or open negotiation periods are missed.
- Package complete dispute files and submit them directly through the federal government's CMS portal.
- Follow up on arbitrator decisions, coordinate administrative fee details, and track accounts receivable to ensure finalized payments are received.
Qualifications
- Demonstrated ability to handle a steep learning curve, fast-paced workflows, and high-pressure deadlines with composure.
- Exceptional organizational skills with a proven track record of managing high-volume data, paperwork, and claims without losing track of details.
Experience
- Strong background in health insurance, medical billing, or healthcare claims administration (e.g., prior experience with payers, TPAs, hospital billing, claims processing, and reading/evaluating EOBs).
- Strong, hands-on experience using CRM/pipeline tools (e.g., Salesforce) to manage cases, update file statuses, and track complex workflows.
- Prior experience with out-of-network claims, surprise billing, or navigating the CMS federal IDR portal (considered a strong plus).
- Experience working with corporate counsel or in legal document production (considered a strong plus).
Skills
- Professional proficiency in Microsoft Office, especially Excel and Word.
Education
- College degree (Bachelor’s degree) and/or Paralegal Certificate (or actively pursuing).
- Certified Paralegal credential (considered a strong plus).
Additional Requirements
- Ability to manage a consistent flow of roughly 60 relevant disputes per month, with total team volume of 90 to 100 disputes/flights per month.
- Monday through Friday, standard 8-to-9 hour shift during traditional business hours, with flexibility to start early and finish early.
- Adaptable, quick study capable of handling a steep learning curve and high-volume expectations.
- Willingness to join a focused, collaborative team with responsibilities evenly distributed.
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.
