Priority Claims Specialist IV

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.

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.

Medicare Audit Specialist

Retrieve and identify Revenue Cycle Management (RCM) documents, updating tracking and billing systems.
• Perform internal and external reviews of data, files, and medical charts to ensure coding accuracy, documentation support, and compliance with Centers for Medicare and Medicaid Services (CMS) guidelines and medical policies.
• Address deficiencies through review and research, consulting with physicians/clinicians and their staff as needed on documentation and regulatory issues.
• Develop and manage professional relationships with colleagues.
• Conduct special projects, including reconciling and reviewing medical necessity, developing spreadsheets, and summarizing outcomes.
• Report anomalies and new trends to the Supervisor immediately.

Reimbursement Specialist

• Prepare and submit complex claims for reimbursement in a managed care environment.
• Assess complex claims to determine denial, audit, and/or retraction risks.
• Serve as a resource and advocate for clinic administration regarding reimbursement and managed care.
• Conduct analytical research and provide expertise on pricing, reimbursement, and claim appeals processes.
• Maintain and support relationships with customers and insurance/managed care organizations to ensure a successful reimbursement program.
• Collaborate closely with field staff, providing training on relevant reimbursement issues.
• Process complex claims with a high degree of accuracy

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

Supervision Received and Exercised:

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

Experience and Education:

Minimum

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

Preferred

• Bachelor's degree
• Licensed Medicare auditor or Certified Medical Audit Specialist

• 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.

#LI-Remote

Pay range of $18.50 to $27.88 per hour + benefits + 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.

• 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