Priority Claims Specialist III

Hanger, Inc.•,

20d•$18 - $26•Remote

About The Position

The Priority Claims Specialist III ensures that payment for services is accurate, timely, and fully documented. This high-dollar medical collections role is part of a Centralized Revenue Cycle Team and focuses primarily on complex denials and appeals. The specialist supports efficient cash collection through reimbursement practices that comply with applicable laws, regulations, Hanger policies, and compliance programs, while following established procedures for adjustments, refunds, and write-offs. The role also provides support and communication to internal and external partners. This is a full-time, remote position scheduled Monday through Friday on the day shift.

Requirements

High school education or equivalent.
At least 4 years of related experience with payer policies, including reimbursement, medical policy, and payer appeal requirements.
Attention to detail and ability to quickly identify trends.
Strong communication and interpersonal skills.
Working knowledge of appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles.
Working knowledge of medical terminology.
Ability to take initiative and proactively resolve problems.
Ability to multitask.
Personal accountability in meeting deadlines.
Working knowledge of Microsoft Office suite programs.
Working knowledge of electronic health records, such as OPS and NextGen.
Ability to pull data and migrate it into online records management systems such as OnBase.
High ethical standards when handling confidential patient and billing information.
Strong oral, telephone, and written communication skills, including ability to follow written and verbal directions.
Ability to work under pressure and be a resourceful, flexible team player.
Knowledge of state, federal, and regional collection and reimbursement laws; HIPAA; medical insurance regulations and terminology; and coding, billing, reimbursement, and documentation protocols for private payer, state, and federal plans.
Proficient computer skills, including Windows-based office technologies such as Word, Excel, and PowerPoint, email, and automated billing systems.
Strong organizational skills and ability to manage multiple tasks with a high degree of detail in a fast-paced environment.

Nice To Haves

Experience with NextGen and/or OnBase.

Responsibilities

Use the company billing and collections system to identify and resolve unpaid, short-paid, and denied claims.
Review EOBs and other insurer correspondence to verify reimbursement against applicable rules, regulations, and contract terms.
Follow up with insurance companies through online portals, phone, email, and/or fax.
Identify billing errors and submit corrected claims to insurance carriers.
Provide timely and accurate account follow-up until resolution.
File and follow up on appeals and disputes, with a primary focus on complex denials and appeals.
Communicate accounts receivable issues that may cause payment delays or write-offs to management.
Document findings clearly and concisely.
Research insurance guidelines and manuals.
Perform system adjustments as needed.
Submit medical records upon request.
Resolve outstanding accounts receivable problems and respond to and resolve inquiries from customers or external collection resources.
Review, monitor, and resolve assigned encounters and reports.
Identify causes of account delinquency and discuss them with management as needed.
Provide timely follow-up on all tasks.
Communicate effectively with Patient Care Clinics regarding collection efforts.
Complete, review, and research deficiencies to ensure they are properly addressed and resolved.
Maintain working knowledge of DMEOPS CPT and ICD-10 codes.