Priority Claims Specialist IV

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

Job summary

Ein führendes Unternehmen im Bereich orthopädischer und prothetischer Dienstleistungen sucht einen Priority Claims Specialist IV. In dieser spannenden Position arbeiten Sie remote und sind verantwortlich für die Überprüfung komplexer Ansprüche und die Sicherstellung der Einhaltung von Medicare-Richtlinien. Sie werden eine Schlüsselrolle bei der Unterstützung von Kliniken und der Kommunikation mit verschiedenen Stakeholdern spielen. Das Unternehmen bietet eine wettbewerbsfähige Vergütung, umfassende Leistungen und die Möglichkeit, einen positiven Einfluss auf das Leben von Patienten zu haben. Wenn Sie eine Leidenschaft für das Gesundheitswesen haben und in einem dynamischen Umfeld arbeiten möchten, könnte dies die perfekte Gelegenheit für Sie sein.

Benefits

Wettbewerbsfähige Vergütung

Bezahlte Feiertage und PTO

Medizinische, Zahn- und Sehversorgung

401k und Rentenpläne

Elternzeit

Mentorship-Programme

Studentenhilfe

Reisegelegenheiten

Freiwilligenprogramme

Qualifications

• Mindestens 6 Jahre Erfahrung mit Payor-Politiken und Rückerstattungen.
• Kenntnisse über Medicare-Audits und -Richtlinien erforderlich.

Responsibilities

• Überprüfung komplexer Ansprüche und Patientenakten.
• Vorbereitung von Rückerstattungsanträgen für komplexe Ansprüche.

Skills

Kommunikationsfähigkeiten

Analytische Fähigkeiten

Kenntnisse über Medicare-Audits

Medizinische Terminologie

Problemlösungsfähigkeiten

Multitasking-Fähigkeiten

Education

High School Diplom

Bachelorabschluss (bevorzugt)

Tools

MS Office

Elektronische Gesundheitsakten (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 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. Our 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. The role also involves maintaining 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. - Perform reviews of data, files, or medical charts to ensure codes billed are appropriate, supported by documentation, and compliant with CMS guidelines and policies. - Complete, review, and research deficiencies. - Consult with physicians/clinicians and staff on documentation and regulatory issues. - Develop and maintain professional relationships with colleagues. - Conduct special projects, including reconciling medical necessity and creating reports.
2. Reimbursement Specialist: - Prepare complex claims reimbursement submissions. - Assess claims to determine risk of denial or audit. - Serve as an advocate for clinic administration regarding reimbursement and managed care. - Conduct analytical research on pricing, reimbursement, and appeals. - Support relationships with customers and insurance organizations. - Provide training on reimbursement issues. - Process complex claims accurately.

Your Impact

Knowledge and Skills:

• Excellent communication and interpersonal skills.
• Analytical skills to identify trends quickly.
• 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 in MS Office and Electronic Health Records such as OPS and NextGen.
• Ability to download and migrate data, e.g., in OnBase.
• High ethical standards regarding confidential information.

Job Complexity: Requires judgment and initiative. Understands work implications and suggests solutions.

Supervision: Determines methods for new assignments; may act as informal team leader.

Minimum Qualifications

Experience and Education:

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

Preferred:

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

Additional Success Factors

• Act with integrity, honesty, and respect.
• Focus on patient-centered care and building trust.
• Foster collaboration and constructive dialogue.
• Innovate and adapt to change.
• Strive for outstanding results and continuous improvement.

#LI-Remote

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

Our Investment in You

• Competitive compensation.
• Paid holidays and PTO.
• Medical, Dental, Vision benefits.
• 401k and retirement plans.
• Parental leave, flexible schedules, and part-time options.
• Employee referral bonuses.
• Mentorship programs.
• Student loan assistance by location.
• Relocation support.
• Travel opportunities.
• Volunteer programs.

Hanger, Inc. is an equal opportunity employer. All employment conditions are applied fairly and without discrimination. We prohibit retaliation against employees supporting discrimination or harassment complaints.