Title: Professional - Appeals Clinician I (B03724) Location: Remote, OR, US Job Description: Job#: 3027339 Professional - Appeals Clinician I Employment Type: Contract Employee Type: Contract Job Type: Pay Range: $25 - $28 per hour Role Overview The Appeals Clinician I utilizes clinical expertise to complete the clinical component of all appeal types to resolve member and/or provider appeals. This role applies nursing expertise and clinical judgment to ensure written appeal decisions are compliant with medical policy, medical necessity guidelines, reimbursement policies, federal regulations, and accepted standards of care. Key Responsibilities - Apply nursing expertise and clinical judgement to ensure written appeal decisions are in compliance with medical policy, medical necessity guidelines, and reimbursement policies. - Conduct clinical appeal reviews which adhere to member benefits and provider and hospital contracts. - Consult with physician advisers to ensure clinically appropriate determinations when required. - Advise and educate non-clinical appeals staff on clinical cases. - Prepare and present clear and concise written narratives and decisions. - Interpret medical records, patient data, and member benefits to communicate complex topics with clinical and non-clinical staff. Required Qualifications Education: Must have at least one of the following: - Bachelor’s degree (or higher) in a health or human services-related field. A psychiatric RN or Master's degree in Behavioral Health is preferred for behavioral health appeals management. - Registered nurse (RN) license with a current unrestricted RN license in Oregon, Washington, Idaho, or Utah. Experience: - Two years of experience in health insurance, Utilization Management, or Appeals Clinical review. - Three years (or full-time equivalent) of direct clinical care experience. - Demonstrated competency in claim review and experience using billing and claims forms. Skills and Knowledge: - Proven knowledge of medical and surgical procedures and other healthcare practices. - Familiarity with rules applied to appeals by accrediting bodies, state and federal governments, and employer groups. - Knowledge of personal computer software, such as Microsoft Word. - Knowledge of CPT, ICD-9, and HCPCS coding and Milliman Care Guidelines (MCG). Work Environment This is a remote position. Candidates must be willing to work Pacific Time Zone hours. The contractor will be provided with company equipment and must have a supported Internet Service Provider (CATV/Cable Modem, DSL, or Fiber). Satellite or mobile WiFi internet connectivity is not supported. Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico. Apex uses a virtual recruiter as part of the application process. Click here for more details. Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Apex team member can provide.

About Our Company: At Infinx, we're a fast-growing company focused on delivering innovative technology solutions to meet our clients' needs. We partner with healthcare providers to leverage automation and intelligence, overcoming revenue cycle challenges and improving reimbursements for patient care. Our clients include physician groups, hospitals, pharmacies, and dental groups. We're looking for experienced associates and partners with expertise in areas that align with our clients' needs. We value individuals who are passionate about helping others, solving challenges, and improving patient care while maximizing revenue. Diversity and inclusivity are central to our values, fostering a workplace where everyone feels valued and heard.A 2025 Great Place to Work® In 2025, Infinx was certified as a Great Place to Work® in both the U.S. and India, underscoring our commitment to fostering a high-trust, high-performance workplace culture. This marks the fourth consecutive year that Infinx India has achieved certification and the first time the company has earned recognition in the U.S. Location: Remote Summary Description: The Profee Coder/Edits & Rejection Specialist supports the RW - Onshore department in various functions, including performing accurate professional fee coding, resolving edits and rejections, and ensuring pro-fee coding compliance. This role is critical in enabling onshore revenue cycle operations to optimize pro-fee billing and revenue capture. The Professional Fee Coder | Edits & Rejection Specialist will also code, audit, provide expertise, and identify process improvements. Job Responsibilities: - Accurately code professional fee services and procedures - Review and resolve coding edits, rejections, and denials - Stay up-to-date with coding guidelines and regulations - Collaborate with physicians and revenue cycle teams to ensure accurate coding - Provide training and education on coding best practices - Assist in other duties as assigned Skills and Education: - High School diploma or equivalent - Vocational school in healthcare or Associate's Degree preferred - Certified CCS, CCS-P, or CPC - 3+ years of experience in medical coding and auditing - Expertise in managing and resolving coding denials and rejections - In-depth knowledge of coding guidelines, regulations, and reimbursement methodologies in relevant speciality area - Proficiency with Epic - Ability to work independently and within a team atmosphere - Advanced and proficient knowledge of ICD-10 CM and ICD-10 - Self-motivated and passionate about our mission and values of quality work - Must have professional level skills in MS products such as Excel, Word, Power Point. - Must be able to type proficiently and with an effective pace - Proficient application of business/office standard processes and technical applications Company Benefits and Perks: Joining Infinx comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization. - Access to a 401(k) Retirement Savings Plan - Comprehensive Medical, Dental, and Vision Coverage - Paid Time Off. - Paid Holidays - Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services If you are a dedicated and experienced ProFeeCoder with experience in Edits, Rejections, and Denials ready to contribute to our mission and be part of our diverse and inclusive community, we invite you to apply and join our team at Infinx.

Role Description The QA Specialist plays a critical role in ensuring the accuracy, compliance, and quality of all Medicare and Medicaid claims before submission. In this high‑volume, detail‑driven position, the QA Specialist reviews patient care reports (PCRs), validates service levels and documentation, and confirms that all regulatory and payer‑specific requirements are met. This role requires clinical insight, exceptional attention to detail, and a commitment to maintaining the highest standards of billing integrity. Essential Duties and Responsibilities - Perform detailed quality reviews of all Medicare/Medicaid claims after coding and before submission to ensure accuracy, compliance, and completeness. - Examine patient care reports (PCRs) to confirm documentation supports the billed level of service and adheres to payer rules and medical necessity standards. - Validate coding selections, including level of service assignments, mileage accuracy, and required clinical indicators. - Ensure documentation compliance with federal, state, and payer regulations, including signature requirements, narratives, interventions, and supporting details. - Verify claim readiness by ensuring all required documentation and attachments are present prior to releasing the claim. - Identify discrepancies or errors and take action to correct, escalate, or return claims to coders for further review. - Maintain high‑volume throughput while consistently meeting accuracy and productivity expectations. - Collaborate with Coding, Billing, QA leadership, and other internal teams to resolve questions or clarify documentation issues. - Support continuous quality improvement by identifying trends, gaps, or training opportunities. - Additional job duties as assigned. Qualifications - Education: High School Diploma or equivalent. - Clinical or medical background strongly preferred: LPN, RN, EMT, Paramedic, LNA, Medical Aide, or equivalent experience. - Strong understanding of medical terminology, EMS clinical documentation, and healthcare billing standards. - Ability to navigate and work efficiently across multiple computer programs simultaneously. - Must have reliable home internet with speeds of 15 Mbps or higher. - Must successfully complete a basic computer skills assessment prior to interview; typing test for speed and accuracy may also be required. - Excellent attention to detail, accuracy, and documentation review skills. - Strong time‑management skills with the ability to meet tight deadlines and maintain high productivity. - Ability to remain focused, organized, and productive in a remote, independent work environment. - Strong communication skills, both written and verbal, with professionalism and excellent judgment. - Dependable, punctual, and comfortable asking questions or seeking clarification when needed. - Ability to remain calm and effective in a fast-paced, time‑sensitive workload environment. - Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment. Physical Requirements - Ability to talk, hear, and see clearly to read and interpret information. - Regular use of a computer, phone, and standard office equipment. - May be required to travel for business purposes. - Ability to secure confidential information. - Perform all duties in a professional environment free of noise or anything that would create a negative customer experience. Benefits - Competitive salary, commensurate with experience. - Comprehensive benefits package, including 401(k) Plan.

Role Description Digitech is seeking a highly motivated and detail‑oriented Insurance Account Resolution Specialist to manage and resolve insurance claims after submission to commercial insurance carriers. This role is responsible for ensuring timely, accurate, and compliant claim resolution by reviewing pending, denied, or incorrectly paid claims and following through until payment is secured. Success in this role requires strong analytical skills, excellent follow‑through, and the ability to manage a high‑volume workload in a fast‑paced environment. - Research and resolve outstanding insurance claims, including those that are pending, unable to be released, denied, or paid incorrectly by commercial insurance carriers. - Investigate claims placed on hold, identifying root causes, correcting errors, and executing needed follow‑up actions to release claims for processing. - Analyze insurance denials, determining denial reasons, assessing validity, and completing the appropriate resolution steps such as appeals, corrections, or resubmissions. - Communicate directly with insurance carriers via outbound calls to obtain claim status, clarify discrepancies, and secure detailed explanations for pending or denied claims. - Prepare and submit additional documentation requested by insurance carriers to support claim adjudication and ensure accurate processing. - Draft and submit appeals when necessary, ensuring they are supported by proper documentation, regulatory guidelines, and payer‑specific requirements. - Process and manage incoming correspondence, including mail, emails, EOBs, requests for information, and any necessary refunds. - Maintain accurate, detailed notes in billing systems for all follow‑up activities, findings, and next steps. - Identify trends or recurring issues, escalating concerns to supervisors or appropriate internal teams to support process improvement. - Meet daily productivity and accuracy expectations, contributing to a high‑performing team environment. - Additional job duties as assigned. Qualifications - Education: High School Diploma or equivalent required. - Strong computer skills, including working knowledge of MS Outlook, Word, and Excel. - Ability to type 40 WPM with accuracy. - Proven ability to handle high‑volume workloads, prioritize effectively, and meet tight deadlines. - Experience in a structured environment where call monitoring, performance metrics, or productivity scoring are used is helpful. - Strong verbal communication skills with the ability to remain calm, professional, and effective during phone interactions with insurance carriers. - Excellent written communication skills for crafting clear, accurate documentation and correspondence. - Exceptional attention to detail and accuracy in reviewing claims, identifying discrepancies, and documenting findings. - Highly organized, self‑paced, and capable of managing work independently in a remote environment. - Dependable, punctual, and accountable, with a willingness to ask questions and seek clarification when needed. - Ability to independently manage all aspects of the job role including required goals and business practices in a remote environment. Requirements - Ability to talk, hear, and see clearly to read and interpret information. - Regular use of a computer, phone, and standard office equipment. - May be required to travel for business purposes. - Ability to secure confidential information. - Perform all duties in a professional environment free of noise or anything that would create a negative customer experience. Benefits - Competitive salary, commensurate with experience. - Comprehensive benefits package, including 401(k) Plan.