Appeals Specialist

Job Summary

Our client is seeking a meticulous Healthcare Appeals Specialist to join their corporate headquarters team. The successful candidate will oversee the end-to-end administration of disputed insurance claims, executing strategic solutions to maximize legitimate provider reimbursement. This is a full-time, on-site role operating during standard business hours.

Key Responsibilities

• Evaluate rejected insurance claims to diagnose root causes and formulate targeted appellate strategies.
• Draft, assemble, and submit comprehensive formal appeal packages backed by robust clinical and administrative documentation.
• Routinely monitor outstanding appeals, maintaining rigorous tracking logs of their current status and progress.
• Serve as the central point of contact to clarify claim statuses and resolve disputes with insurance carriers, clinical personnel, and patients.
• Archive precise, audit-ready documentation detailing all appeal submissions, correspondence, and operational actions.
• Evaluate the results of resolved appeals to identify systemic payment trends and recommend long-term improvements for the billing cycle.
• Proactively monitor changing insurance policies, governmental healthcare mandates, and regional payer regulations to maintain absolute compliance.

Qualifications

• 2+ years experience in medical billing, claims processing or appeals management (Provider or professional side - not facility).
• Strong knowledge of CPT and ICD-10 codes.
• Medical terminology knowledge.
• Familiarity with insurance policies on commercial and government payers.
• Bachelor's degree in healthcare administration or related field.
• Anesthesia or related specialty experience.

Skills

• Strong knowledge of CPT and ICD-10 codes.
• Medical terminology knowledge.
• Familiarity with insurance policies on commercial and government payers.

For California Applicants:

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).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. 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.

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?