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Priority Claims Specialist I

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Hanger, Inc.

24d ago

  • Job
    Full-time
    Junior Level
  • Customer Relations
    Healthcare
  • United States
    Remote

AI generated summary

  • You need a high school diploma, up to 1 year of experience, attention to detail, strong communication skills, knowledge of Medicare policies, MS Office, EHR, and a commitment to patient confidentiality.
  • You will manage claims, ensure compliance with coding and documentation, resolve deficiencies, perform research, build relationships, and advocate for reimbursement processes.

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 OnBase
  • 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

Responsibilities

  • 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

FAQs

Do we support remote work?

Yes, this position is remote.

What is the primary responsibility of the Priority Claims Specialist I?

The primary responsibility includes reviewing complex claims, patient records, and hospital and physician billing practices to identify discrepancies or errors in payments made to Medicare providers.

What qualifications do I need for this role?

A high school education or equivalent is required, along with up to 1 year of related experience.

What skills are preferred for this position?

Preferred skills include attention to detail, good communication and interpersonal skills, general knowledge of Medicare audit, appeals, reimbursement, medical terminology, and proficiency in MS Office and Electronic Health Records (EHR).

What is the pay range for this position?

The pay range is $17.75 to $24.71 per hour, plus an annual bonus of up to 5% of base pay based on bonus criteria.

What benefits are offered to employees?

Benefits include competitive compensation packages, paid national holidays, PTO, medical, dental, and vision benefits, a 401k savings plan, paid parental bonding leave, flexible work schedules, and more.

Will I have the opportunity for professional development?

Yes, Hanger offers mentorship programs and potential participation in volunteering for local and national events.

How does Hanger, Inc. ensure equal employment opportunity?

Hanger, Inc. is committed to providing equal employment opportunities and prohibits discrimination or harassment based on various protected characteristics as outlined in their employment policy.

What types of special projects might I be involved in?

Special projects may include reconciling and reviewing medical necessity, as well as developing spreadsheets and summarizing outcomes.

Will I be responsible for training field staff?

Yes, this position may involve working closely with field staff and providing training on relevant reimbursement issues.

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Hanger, Inc.

Empowering Human Potential

Science & Healthcare
Industry
501-1000
Employees
1861
Founded Year

Mission & Purpose

Headquartered in Austin, Texas, Hanger, Inc. is a leading provider of orthotic and prosthetic (O&P) patient care services and products. The company operates as an ecosystem of diversified companies delivering complementary solutions to individuals and providers with O&P needs, and is organized in two business segments – Patient Care and Products & Services. Through its Patient Care segment, Hanger provides comprehensive, outcomes-based O&P services to individuals of all ages at more than 925 Hanger Clinic locations nationwide. Through its Products & Services segment, Hanger serves the broader O&P community and skilled nursing facilities through designing and distributing branded and private label O&P devices, products and components, and post-acute rehabilitative solutions. Rooted in clinical research, excellence, and innovation, Hanger is a purpose-driven company focused on empowering human potential.