Priority Claims Specialist IV

Hanger, Inc.; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Priority Claims Specialist IV to enhance patient care through meticulous claim reviews and effective communication. This remote role involves analyzing Medicare claims, ensuring compliance with guidelines, and collaborating with clinics to resolve billing issues. Join a team dedicated to empowering human potential, where your expertise will directly impact patient outcomes and operational excellence. With competitive pay, flexible schedules, and a supportive work environment, this opportunity is perfect for those looking to make a meaningful difference in healthcare.

Benefits

Paid holidays

PTO

Health benefits

401k

Parental leave

Flexible schedules

Referral bonuses

Mentorship

Student loan assistance

Travel opportunities

Qualifications

• 6+ years of experience with payor policies and reimbursement.
• High school diploma required; Bachelor's preferred.

Responsibilities

• Review complex claims and identify discrepancies.
• Prepare claims reimbursement submissions and assess risks.

Skills

Excellent communication and interpersonal skills

Analytical skills

Knowledge of Medicare audits

Experience with medical terminology

Proactive problem-solving skills

Ability to multi-task

Proficiency with MS Office

Experience with EHR systems

Education

High school diploma or equivalent

Bachelor’s degree

Tools

MS Office

EHR systems (OPS, NextGen)

OnBase

Job description

Why Us?

With a mantra of Empowering Human Potential, Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products. We offer 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, our vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services, and value. Our employees touch thousands of lives daily, helping people achieve new levels of 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, hospital and physician billing practices, and identifying discrepancies or errors in payments made to Medicare providers. You will maintain support and communication with clinics, employees, and management.

Principal Duties and Responsibilities (Essential Functions):

1. Medicare Audit Specialist: - Retrieve and identify documents from Revenue Cycle Management (RCM) system. - Update tracking and billing systems. - Review data, files, or medical charts to ensure billed codes are appropriate, supported by documentation, and comply with CMS guidelines and policies. - Address deficiencies through review and research. - Consult with physicians/clinicians on documentation and regulatory issues. - Develop professional relationships with colleagues. - Conduct special projects, including reconciling medical necessity, and create reports. - Report anomalies and trends to supervisors.
2. Reimbursement Specialist: - Prepare complex claims reimbursement submissions in a managed care environment. - Assess claims for risk of denial or audit. - Serve as an advocate for clinic reimbursement issues. - Conduct analytical research on pricing, reimbursement, and appeals. - Maintain relationships with payers. - Train field staff on reimbursement issues. - Process complex claims accurately.

Your Impact

Knowledge and Skills:

• 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.
• Ability to multi-task and meet deadlines.
• Proficiency with MS Office and EHR systems like OPS and NextGen.
• Ability to download and migrate data, e.g., OnBase.
• High ethical standards regarding confidential information.

Job Complexity: Works on assignments requiring judgment and initiative. Understands work implications and suggests solutions.

Supervision: Determines methods on new assignments; may lead teams.

Minimum Qualifications

Experience and Education:

• High school diploma or equivalent.
• At least 6 years of experience with payor policies, reimbursement, policies, and appeals.

Preferred:

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

Additional Success Factors

• Act with integrity, honesty, and respect.
• Center work around patient trust.
• Foster collaboration and dialogue.
• Innovate and adapt to change.
• Focus on outcomes and process excellence.

#LI-Remote

Pay range: $18.50-$27.88/hr + benefits + bonus (up to 5%). Compensation varies based on skills, location, and other factors.

Our Investment in You

• Competitive pay and benefits.
• Paid holidays, PTO, health benefits, 401k, parental leave, flexible schedules, referral bonuses, mentorship, student loan assistance, relocation, travel opportunities, volunteering.

Hanger, Inc. is committed to equal employment opportunity and prohibits discrimination and harassment in all forms. We comply with all applicable laws.