Priority Claims Specialist IV

Hanger, Inc.; Milwaukee (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Priority Claims Specialist IV to join their remote team. In this pivotal role, you will review complex claims, ensuring compliance with Medicare guidelines, while maintaining communication with clinics and management. Your analytical skills will be crucial in identifying discrepancies and advocating for reimbursement. With a focus on patient-centered care and a commitment to integrity, this position offers a unique opportunity to impact lives positively. Join a forward-thinking company that values your contributions and offers competitive pay and a comprehensive benefits package.

Benefits

Paid Holidays

Health Insurance

401k

Flexible Schedules

Referral Bonuses

Student Loan Assistance

Relocation Support

Qualifications

• 6 years' experience with payor policies and reimbursement.
• Knowledge of medical terminology and appeals processes.

Responsibilities

• Review complex claims and patient records for discrepancies.
• Prepare claims and advocate for reimbursement with payers.

Skills

Analytical Skills

Communication Skills

Problem-Solving Skills

Knowledge of Medicare Audits

Multi-tasking Ability

Education

High School Diploma

Bachelor's Degree (Preferred)

Tools

MS Office

EHR Systems (OPS, NextGen)

Job description

Priority Claims Specialist IV

Job ID: 2025-29574

• # Positions: 1
• Job Location: US
• Telecommute: Telecommute (U.S.) Position
• FT/PT: Full-Time
• Category: Medical Office Professionals

Why Us?

Hanger, Inc., with a mantra of Empowering Human Potential, is the world's leading provider of orthotic and prosthetic (O&P) services and products. We offer advanced solutions, differentiated programs, and exceptional customer service. Our Patient Care segment operates numerous clinics nationwide, and through our Products & Services segment, we distribute O&P devices and rehabilitative solutions. With 160 years of clinical excellence, our vision is to lead the O&P markets by providing superior care, outcomes, and value. Our employees touch thousands of lives daily, helping people achieve mobility and freedom.

Could This Be For You?

We are seeking to hire a Priority Claims Specialist IV - Remote. The primary responsibilities include reviewing complex claims, patient records, and hospital and physician billing practices, identifying discrepancies or errors in payments to Medicare providers, and maintaining communication with clinics, employees, and management.

Principal Duties and Responsibilities

1. Medicare Audit Specialist: Retrieve and identify documents from Revenue Cycle Management systems, update tracking and billing systems, review medical records for code accuracy and compliance with CMS guidelines, address deficiencies, consult with clinicians, develop relationships, and conduct special projects including data reconciliation and reporting.
2. Reimbursement Specialist: Prepare complex claims, assess risk of denial, serve as an advocate for reimbursement, conduct analytical research on pricing and claims, maintain relationships with payers, and train field staff on reimbursement issues.

Your Impact

• Excellent communication and interpersonal skills
• Analytical skills to identify trends
• High knowledge of Medicare audits, appeals, reimbursement, LCDs, and policies
• Experience with medical terminology
• Proactive problem-solving skills
• Multi-tasking ability
• Deadline-oriented and ethical standards for confidentiality
• Proficiency in MS Office and EHR systems like OPS and NextGen

Minimum Qualifications

• High school diploma or equivalent
• 6 years' experience with payor policies, reimbursement, medical policies, and appeals

Preferred qualifications include a Bachelor's degree and relevant certifications such as Licensed Medicare auditor or Certified Medical Audit Specialist.

Additional Success Factors

• Integrity, transparency, and respect
• Patient-centered approach
• Open collaboration and innovation
• Focus on outcomes and process improvement

Compensation and Benefits

Pay range of $18.50 to $27.88/hour plus benefits and bonuses. Benefits include paid holidays, PTO, health insurance, 401k, parental leave, flexible schedules, referral bonuses, mentorship programs, student loan assistance, and relocation support.

Our Investment in You

• Competitive pay and benefits
• Paid holidays and time off
• Health, dental, vision coverage
• Retirement plans
• Work-life balance initiatives

Equal Opportunity Employment

Hanger, Inc. provides equal employment opportunities and complies with applicable laws. Discrimination or harassment based on protected characteristics is prohibited.