Priority Claims Specialist IV

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 to hire a Priority Claims Specialist IV - Remote, the 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.

Principal Duties and Responsibilities (Essential Functions) : Medicare Audit Specialist : - Retrieve and properly identify any document received from Revenue Cycle Management (RCM) system - 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 - Complete, review, and research any deficiency to ensure that any deficiency is properly addressed - Consult with physicians / clinicians and their staff (if acceptable within the Region), as needed, on documentation issues, and other regulatory issues as they arise - Develop and manage relationships with colleagues in a professional - 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 - Report anomalies and new trends immediately to Supervisor for additional input. Reimbursement Specialist : - Prepare complex claims reimbursement submissions in a managed care environment - Assess complex claims to determine risk of denial, audit, and / or retraction - Serve as an advocate and resource to clinic administration in the areas of reimbursement and managed care - Conduct analytical research and provide expertise on items; such as; pricing, reimbursement, and claim appeals process - Maintain and support relationships with customers and insurance / managed care organizations to ensure a successful reimbursement program - Work closely with field staff and may provide training on relevant reimbursement issues - Process complex claims with a high degree of accuracy.

Your Impact

Knowledge and Skill :

• Excellent communication and interpersonal skills
• Analytical with the ability to quickly identify trends
• High level knowledge of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles
• Experience with usage and application of medical terminology
• Self-starter / take initiative to proactively resolve problems
• Ability to multi-task
• Accountable and meet deadlines on a regular basis
• High level experience with MS Office suite programs.
• High level knowledge of Electronic Health Records (EHR); such as, OPS and NextGen
• Advance capabilities to download and migrate data in to various systems; such as OnBase
• Demonstrate high ethical standards regarding confidential patient and billing information

Job Complexity :

Works on assignments requiring considerable judgment and initiative. Understands implications of work and makes recommendations for solutions.

Supervision Received and Exercised :

Determines methods and procedures on new assignments. May be informal team leader.

Minimum Qualifications

Experience and Education :

Minimum

Preferred

Additional Success Factors

Our Investment in You

Hanger, Inc. is committed to providing equal employment opportunity in all aspects of the employer-employee relationship. All conditions and privileges of employment are administered to all employees without discrimination or harassment because of race, religious creed, color, age, sex, sexual orientation, gender identity, national origin, religion, marital status, medical condition, physical or mental disability, military service, pregnancy, childbirth and related medical conditions, special disabled veteran status, or any other classification protected by federal, state, and local laws and ordinances. The company will comply with all applicable state or local fair employment laws that forbid discrimination or harassment on the basis of other protected characteristics. Retaliation against any employee for filing or supporting a complaint of discrimination or harassment is prohibited.