Hanger, Inc. hiring Priority Claims Specialist III in United States | LinkedIn
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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. 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):
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
Minimum Qualifications
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
Additional Success Factors
Attention to detail with the ability to quickly identify trends
Strong communication and interpersonal skills
Working knowledge of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs) , and policy articles
Working knowledge of medical terminology
Self-starter / take initiative to proactively resolve problems
Ability to multi-task
Strong sense of personal accountability to meet deadlines
Working knowledge of MS Office suite programs.
Working knowledge of Electronic Health Records (EHR); such as, OPS and NextGen
Demonstrated ability to pull data and migrate into online records management systems such as OnBase;
Demonstrate high ethical standards regarding confidential patient and billing information
Act with integrity in all ways and at all times, remaining honest, transparent, and respectful in all relationships.
Keep the patient at the center of everything that you do, building lifelong trust.
Foster open collaboration and constructive dialogue with everyone around you.
Continuously innovate new solutions, influencing and responding to change.
Focus on superior outcomes, and calibrate work processes for outstanding results.
Pay range of $17.95 to $23.00 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.
Our Investment in You
Competitive Compensation Packages
8 Paid National Holidays & 4 additional Floating Holidays
PTO that includes Vacation and Sick time
Medical, Dental, and Vision Benefits
401k Savings and Retirement Plan
Paid Parental Bonding Leave for New Parents
Flexible Work Schedules and Part-time Opportunities
Generous Employee Referral Bonus Program
Mentorship Programs- Mentor and Mentee
Student Loan Repayment Assistance by Location
Relocation Assistance
Regional & National traveling CPO/CO/CP opportunities
Volunteering for Local and National events such as Hanger’s BAKA Bootcamp and EmpowerFest
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.
#ERF-HRC
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Hospitals and Health Care
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