Priority Claims Specialist IV

Hanger Inc; Wichita (KS); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is looking for a dedicated Priority Claims Specialist IV to join their remote team. This role is pivotal in reviewing complex claims and ensuring compliance with Medicare policies. You will be responsible for maintaining communication with clinics and management while advocating for reimbursement issues. The ideal candidate will possess strong analytical skills and a deep understanding of medical terminology. Join a forward-thinking organization that values integrity and collaboration, and make a meaningful impact in the lives of patients seeking mobility and freedom.

Qualifications

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

Responsibilities

• Review complex claims and patient records for accuracy.
• Consult with healthcare providers and handle special projects.

Skills

Analytical Ability

Communication Skills

Knowledge of Medicare Policies

Medical Terminology

Proficiency in MS Office

EHR Systems

Data Migration Skills

Education

High School Diploma

Bachelor's Degree

Tools

EHR Systems

Revenue Cycle Management Systems

Billing 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 advanced solutions, differentiated programs, and excellent customer service. Hanger's Patient Care segment is the largest owner and operator of O&P clinics nationwide. Through its Products & Services segment, Hanger distributes branded and private label O&P devices and provides rehabilitative solutions. With 160 years of clinical excellence, Hanger aims to lead the market by providing superior patient 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. Your primary responsibilities will include reviewing complex claims, patient records, and hospital and physician billing practices, identifying discrepancies or errors in Medicare payments, and maintaining communication with clinics, employees, and management.

Principal Duties and Responsibilities:

• Medicare Audit Specialist: Retrieve and identify documents from Revenue Cycle Management systems, update tracking and billing systems, review data and medical charts to ensure billing accuracy and compliance with CMS guidelines, address deficiencies, consult with healthcare providers, develop professional relationships, and handle special projects including data reconciliation and reporting anomalies.
• Reimbursement Specialist: Prepare complex claims, assess risks of denial or audit, serve as an advocate for reimbursement issues, conduct research on pricing and appeals, support relationships with payors, train field staff on reimbursement issues, and process claims accurately.

Your Impact:

Skills required include excellent communication, analytical ability, high knowledge of Medicare policies, medical terminology, proficiency in MS Office and EHR systems, data migration skills, and high ethical standards regarding patient information.

Job Complexity:

This role involves assignments requiring judgment and initiative, with understanding of implications and solutions.

Supervision:

Determines methods for new assignments, may act as an informal team leader.

Minimum Qualifications:

• High school diploma or equivalent
• 6 years of experience in payor policies, reimbursement, medical policy, and appeals

Preferred Qualifications:

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

Additional Success Factors:

• Act with integrity, prioritize patient trust, foster collaboration, innovate solutions, focus on outcomes.

#LI-Remote

Pay range: $18.50 to $27.88/hour + benefits + bonus. Compensation varies based on skills, location, and other factors.