Priority Claims Specialist Iii

Why Us?
With a mantra of Empowering Human Potential, Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, clinically differentiated programs and unsurpassed customer service. Hanger's Patient Care segment is the largest owner and operator of O&P patient care clinics nationwide. Through its Products & Services segment, Hanger distributes branded and private label O&P devices, products and components, and provides rehabilitative solutions to the broader market. With 160 years of clinical excellence and innovation, Hanger's vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value. Collectively, Hanger employees touch thousands of lives each day, helping people achieve new levels of mobility and freedom.
Could This Be For You?
We are seeking a Priority Claims Specialist III - Remote who's primary responsibilities includes reviewing complex claims, patient records and hospital and physician billing practices and identifying any discrepancies or errors in payments made to Medicare providers; while maintaining support and communication with Clinics, employees, and management alike.
Your Impact
Medicare Audit Specialist
Principal Duties and Responsibilities (Essential Functions):

• Report anomalies and new trends immediately to Supervisor for additional input.
• Update tracking and billing systems accordingly - Perform internal and external data, files, or medical chart reviews to assure that codes billed are appropriate and supported by documentation in the records and comply with Centers for Medicare and Medicaid Services (CMS) guidelines and medical policies
• Retrieve and properly identify any document received from Revenue Cycle Management (RCM) system
• Responsible for conducting special projects, which may include reconciling and reviewing medical necessity, as necessary. Special projects may require spreadsheet development as well as reports that summarize outcome of special projects
• Develop and manage relationships with colleagues in a professional
• Consult with physicians / clinicians and their staff (if acceptable within the Region), as needed, on documentation issues, and other regulatory issues as they arise
• Complete, review, and research any deficiency to ensure that any deficiency is properly addressed

Reimbursement Specialist

• Maintain and support relationships with customers and insurance/managed care organizations to ensure a successful reimbursement program
• Assess complex claims to determine risk of denial, audit, and/or retraction
• Conduct analytical research and provide expertise on items; such as; pricing, reimbursement, and claim appeals process
• Process complex claims with a high degree of accuracy
• Serve as an advocate and resource to clinic administration in the areas of reimbursement and managed care
• Prepare complex claims reimbursement submissions in a managed care environment
• Work closely with field staff and may provide training on relevant reimbursement issues

Minimum Qualifications
Experience and Education:
Minimum

• High school education or equivalent and
• 4 years of related experience in payor policies to include all areas of reimbursement, medical policy and payor appeal requirements.

Preferred

• B achelor’s degree
• Licensed Medicare auditor or Certified Medical Audit Specialist

Knowledge And Skill

• Working knowledge of MS Office suite programs.
• Attention to detail with the ability to quickly identify trends
• Self-starter / take initiative to proactively resolve problems
• Strong sense of personal accountability to meet deadlines
• Working knowledge of Electronic Health Records (EHR); such as, OPS and NextGen
• Working knowledge of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs) , and policy articles
• Ability to multi-task
• Demonstrated ability to pull data and migrate into online records management systems such as OnBase;
• Strong communication and interpersonal skills
• Working knowledge of medical terminology
• Demonstrate high ethical standards regarding confidential patient and billing information

Additional Success Factors

• Foster open collaboration and constructive dialogue with everyone around you.
• Keep the patient at the center of everything that you do, building lifelong trust.
• Continuously innovate new solutions, influencing and responding to change.
• Focus on superior outcomes, and calibrate work processes for outstanding results.
• Act with integrity in all ways and at all times, remaining honest, transparent, and respectful in all relationships.

Our Investment in You
Employees working at least 20 hours per week are eligible for the following benefits:

• Paid Vacation Time Off
• Dependent Care Flex Spend Account
• 401(k)
• Free employee assistance program
• Medical Flex Spend Account
• Dental Insurance
• Competitive Pay
• Life Insurance
• 8 Paid Holidays per Year
• Paid Sick Time Off
• 8 hours of paid time to volunteer in your community
• Vision Insurance
• Full-time employees are also eligible for short-term and long-term disability insurance
• Floating Holiday
• Health Insurance

Pay range of $17.95 to $26.93 per hour + annual bonus: up to 5% of base pay depending on bonus criteria. This pay range is posted to comply with wage transparency laws. Hanger salary ranges vary based on skill, ability, knowledge, geographic location and other variables.