Priority Claims Specialist IV

Hanger; United States; Remote; Full time

Job summary

A leading company in orthotic and prosthetic services is seeking a Priority Claims Specialist IV. This remote role involves reviewing complex claims, ensuring compliance with Medicare guidelines, and maintaining communication with clinics. The ideal candidate will possess strong analytical and communication skills, with extensive experience in reimbursement processes. Join a team dedicated to empowering human potential and making a significant impact on patient care.

Benefits

Paid holidays and floating holidays

PTO including vacation and sick leave

Medical, Dental, Vision benefits

401k and retirement plans

Paid parental leave

Flexible schedules and part-time options

Referral bonuses

Mentorship programs

Student loan repayment assistance

Travel opportunities

Qualifications

• At least 6 years of experience with payor policies and reimbursement.
• High knowledge of Medicare audits and appeals.

Responsibilities

• Review complex claims and patient records.
• Prepare complex claims reimbursement submissions.
• Maintain support and communication with clinics and management.

Skills

Communication

Analytical

Problem-Solving

Multitasking

Education

High school diploma or equivalent

Bachelor’s degree

Tools

MS Office

Electronic Health Records (EHR)

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. 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 properly identify documents received from Revenue Cycle Management (RCM) system
• Update tracking and billing systems accordingly
• Perform internal and external data, files, or medical chart reviews 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 and staff on documentation and regulatory issues
• Develop and manage professional relationships with colleagues
• Conduct special projects, including reconciling medical necessity, with reporting and analysis
• Report anomalies and trends promptly to supervisors

Reimbursement Specialist:

• Prepare complex claims reimbursement submissions in managed care environments
• Assess claims for risk of denial or audit
• Support clinic administration in reimbursement and managed care issues
• Conduct 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 policy articles
• Experience with medical terminology
• Proactive problem-solving skills
• Ability to multitask and meet deadlines
• Proficiency in MS Office and Electronic Health Records (EHR) systems such as OPS and NextGen
• Ability to download and migrate data across systems like OnBase
• High ethical standards for handling confidential information

Job Complexity:

Requires judgment and initiative; understanding implications and making recommendations.

Supervision:

Determines methods for new assignments; may serve as an 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 payor appeals

Preferred:

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

Additional Success Factors

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

#LI-Remote

Pay range of $18.50 to $27.88 per hour + benefits + annual bonus: up to 5% of base pay depending on bonus criteria. This range complies with wage transparency laws and varies based on skills, location, and other factors.

Our Investment in You

• Competitive compensation
• Paid holidays and floating holidays
• PTO including vacation and sick leave
• Medical, Dental, Vision benefits
• 401k and retirement plans
• Paid parental leave
• Flexible schedules and part-time options
• Referral bonuses
• Mentorship programs
• Student loan repayment assistance by location
• Relocation assistance
• Travel opportunities
• Volunteer opportunities

Hanger, Inc. is an equal opportunity employer. We prohibit discrimination and harassment based on protected characteristics and comply with all applicable laws. Retaliation against employees supporting discrimination or harassment complaints is prohibited.

#ERF-HRC