Priority Claims Specialist IV

Freddie Mac; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company in orthotic and prosthetic services seeks a Priority Claims Specialist IV to manage complex claims and ensure compliance with Medicare guidelines. The role involves communication with clinics and handling reimbursement issues, requiring strong analytical skills and experience in the field.

Benefits

Health benefits

401k

Parental leave

Flexible scheduling

Referral bonuses

Mentorship

Student loan assistance

Travel opportunities

Community involvement

Qualifications

• 6 years of experience with payor policies, reimbursement, and appeals.
• Knowledge of Medicare audits, appeals, and reimbursement policies.

Responsibilities

• Review complex claims and patient records for discrepancies.
• Prepare complex claims reimbursement submissions.
• Maintain relationships with insurance and managed care organizations.

Skills

Communication

Analytical Skills

Problem Solving

Multitasking

Education

High school diploma or equivalent

Bachelor's degree

Tools

MS Office

EHR systems

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, 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.

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, while maintaining support and communication with clinics, employees, and management.

Principal Duties and Responsibilities (Essential Functions):

1. Medicare Audit Specialist:
   • Retrieve and identify documents received from Revenue Cycle Management (RCM) system.
   • Update tracking and billing systems accordingly.
   • Perform reviews of data, files, or medical charts to ensure billed codes are appropriate, documented correctly, and compliant with CMS guidelines and policies.
   • Address deficiencies through research and communication with physicians/clinicians.
   • Develop and manage professional relationships with colleagues.
   • Conduct special projects, including reconciliation and review of medical necessity, with reporting outcomes.
   • Report anomalies and trends to supervisors promptly.
2. Reimbursement Specialist:
   • Prepare complex claims reimbursement submissions.
   • Assess claims for denial risk, audits, and retractions.
   • Serve as an advocate and resource for reimbursement and managed care issues.
   • Conduct analytical research on pricing, reimbursement, and appeals.
   • Maintain relationships with insurance and managed care organizations.
   • Assist field staff and provide training 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 and EHR systems.
• Proactive problem-solving abilities.
• Multitasking and deadline management skills.
• Proficiency in MS Office and data migration tools.
• High ethical standards for confidentiality.

Job Complexity:

Requires judgment and initiative; understanding work implications and recommending solutions.

Supervision:

Determines methods for new assignments; may lead teams informally.

Minimum Qualifications:

Experience and Education:

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

Preferred:

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

Additional Success Factors

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

Additional Information

Pay range: $18.50 to $27.88 per hour + benefits + bonus. We offer competitive packages, paid holidays, PTO, health benefits, 401k, parental leave, flexible scheduling, referral bonuses, mentorship, student loan assistance, relocation, travel opportunities, and community involvement.

Hanger is committed to equal employment opportunity and prohibits discrimination or harassment based on protected characteristics.