Priority Claims Specialist III

Hanger, Inc.•,

4d•$18 - $26•Remote

About The Position

The Priority Claims Specialist III - Remote will ensure payment for services provided is accurate, timely and fully documented. Provide efficient cash collection through excellent reimbursement practices while ensuring compliance with relevant laws, regulations and established Hanger policies and compliance programs. Provides strict adherence to adjustment, refund and write-off policies/procedures as outlined in Hanger Clinic Standard Operating Procedures. Maintain exceptional support and communication with all partners, internal and external. This is a high-dollar medical collections role operating within a Centralized Revenue Cycle Team. This is a full time, remote opportunity. Schedule will be Monday - Friday, day shift.

Requirements

High school education or equivalent
4 years of related experience in payor policies to include all areas of reimbursement, medical policy and payor appeal requirements.
Attention to detail with the 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.
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.
Strong interpersonal, oral (including telephone) and written communication skills, including the ability to follow written and verbal directions.
Works well under pressure
Attention to detail with the ability to quickly identify trends.
Resourceful and flexible team player who excels at building trusting relationships with patients, insurance companies and colleagues.
Excellent knowledge and understanding of state, federal, regional collection and reimbursement laws, HIPAA and other medical insurance regulations and terminology (CPT, ICD-9, HCPCS, modifiers, coding, and documentation guidelines) for private payer, state and federal plans including coding, billing and reimbursement protocols.
Proficient computer skills including Windows based office technologies (ex. Word, Excel, PowerPoint), e-mail and automated billing systems.
Excellent organizational skills and the ability to manage multiple tasks (ex. multitasking) with a high degree of detail orientation while working in a fast-paced environment.
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.

Nice To Haves

Experience with NextGen and/or OnBase.

Responsibilities

Utilize the company billing and collections system to identify and resolve any claims that have been unpaid, short paid and/or denied.
Review EOB's and other correspondence from insurance companies for correct reimbursement according to rules and regulations and contract terms.
Follow up with insurance companies by online portal, phone, email and/or fax.
Identify billing errors and submitted corrected claims insurance carriers.
Provide timely and accurate follow up on accounts until they are resolved.
File and follow up on appeals and disputes.
Communicate identified AR issues that may cause payment delays or write offs to management.
Document all findings with clear and concise detail.
Research insurance guidelines and manuals for additional information.
Perform adjustments in the system as needed.
Submit medical records upon request.
Resolves outstanding accounts receivable problems.
Respond to and resolve inquiries from customers or external collection resources.
Primary focus is on complex denials and appeals.
Review, monitor and resolve assigned encounters and all assigned reports.
Identify issues attributing to account delinquency and discuss them with management as needed.
Provide timely follow-up on all tasks.
Effective communication with Patient Care Clinics related to collection efforts.
Complete, review, and research any deficiency to ensure that any deficiency is properly addressed and resolved.
Maintain a working knowledge and understanding of DMEOPS CPT and ICD-10 codes.