Priority Claims Specialist

5 days ago

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Hanger, Inc.

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Hanger, Inc. is a purpose-driven company that focuses on empowering human potential by providing advanced orthotic and prosthetic services and solutions. With a commitment to clinical research, innovation, and exceptional customer service, Hanger operates 925 patient care clinics nationwide and is supported by 6,400 employees dedicated to moving lives forward. The company treats approximately one million patients annually, showcasing its significant impact in the healthcare sector.

Prosthetics • Orthotics

5001 - 10000 employees

Founded 1861

⚕️ Healthcare Insurance

🧬 Biotechnology

🧘 Wellness

📋 Description

• Retrieve and properly identify any document received from Revenue Cycle Management (RCM) system • Update tracking and billing systems accordingly • Perform internal and external data, files, or medical chart reviews to assure that codes billed are appropriate and supported by documentation in the records and comply with Centers for Medicare and Medicaid Services (CMS) guidelines and medical policies • Complete, review, and research any deficiency to ensure that any deficiency is properly addressed • Consult with physicians / clinicians and their staff (if acceptable within the Region), as needed, on documentation issues, and other regulatory issues as they arise • Develop and manage relationships with colleagues in a professional • Responsible for conducting special projects, which may include reconciling and reviewing medical necessity, as necessary • Special projects may require spreadsheet development as well as reports that summarize outcome of special projects • Report anomalies and new trends immediately to Supervisor for additional input • Prepare complex claims reimbursement submissions in a managed care environment • Assess complex claims to determine risk of denial, audit, and/or retraction • Serve as an advocate and resource to clinic administration in the areas of reimbursement and managed care • Conduct analytical research and provide expertise on items; such as; pricing, reimbursement, and claim appeals process • Maintain and support relationships with customers and insurance/managed care organizations to ensure a successful reimbursement program • Work closely with field staff and may provide training on relevant reimbursement issues • Process complex claims with a high degree of accuracy

🎯 Requirements

• High school education or equivalent • Requires up to 1 year of related experience • Attention to detail with the ability to quickly identify trends • Good communication and interpersonal skills • General knowledge of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs) , and policy articles • General knowledge of medical terminology • Self-starter / take initiative to pro-actively resolve problems • Reliable and able to meet deadlines • General knowledge of MS Office suite programs • General knowledge of Electronic Health Records (EHR); such as, OPS and NextGen • Ability to pull data and migrate into OnBase; for OPS sites need to be scanned into On Base • Demonstrate high ethical standards regarding confidential patient and billing information • Act with integrity in all ways and at all times, remaining honest, transparent, and respectful in all relationships • Keep the patient at the center of everything that you do, building lifelong trust • Foster open collaboration and constructive dialogue with everyone around you • Continuously innovate new solutions, influencing and responding to change • Focus on superior outcomes, and calibrate work processes for outstanding results

🏖️ Benefits

• Competitive Compensation Packages • 8 Paid National Holidays & 4 additional Floating Holidays • PTO that includes Vacation and Sick time • Medical, Dental, and Vision Benefits • 401k Savings and Retirement Plan • Paid Parental Bonding Leave for New Parents • Flexible Work Schedules and Part-time Opportunities • Generous Employee Referral Bonus Program • Mentorship Programs- Mentor and Mentee • Student Loan Repayment Assistance by Location • Relocation Assistance • Regional & National traveling CPO/CO/CP opportunities • Volunteering for Local and National events such as Hanger’s BAKA Bootcamp and EmpowerFest