Priority Claims Specialist III

Hanger, Inc.

124d • $19 - $29

About The Position

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.

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.

Nice To Haves

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

Responsibilities

• 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 manner.
• Conduct special projects, which may include reconciling and reviewing medical necessity, as necessary.
• Report anomalies and new trends immediately to Supervisor for additional input.
• 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.

Benefits

• 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.

What This Job Offers

• Education Level: High school or GED