• Priority Claims Specialist II

    Job Location US
    Job ID
    2018-13878
    # Positions
    1
    Posted Date
    1 week ago(6/11/2018 4:00 PM)
    Category
    Administrative/Clerical
  • 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. Built on the legacy of James Edward Hanger, the first amputee of the American Civil War, Hanger is steeped in 150 years of clinical excellence and innovation with a vision to be the partner of choice for products and services that enhance human physical capability. Collectively, Hanger employees touch thousands of lives each day, helping people achieve new levels of mobility and freedom.

     

    Hanger, Inc. is an equal opportunity employer - female/minority/disability/vet.

    Could This Be For You?

    The Priority Claims Specialist will manage the Customer Operations triage queue, resolving daily issues for the Hanger Clinics and communicating with Hanger Clinics and contracted payers (approximately $800M in annual revenue). This position will be a key member on all future mergers, acquisitions and critical business initiatives. ( i.e., Project TIN Mergers).

    Your Impact

    • Communicate to payer to resolve and confirm/report out findings
    • Based on cases received in queue,  identify trends and report findings/recommendations to Manage for additional escalation
    • Create and send customized provider directories to assigned national and regional payers
    • Will be required to perform essential duties for in support of all clean claim initiatives and RCM deliverables
    • Will confirm monthly provider updates that have been made within those assigned payers’ systems to ensure accurate claims processing and reduce claims denials. Cases will need to be submitted for loading the Clinics to payers. 
    • Assist the Manager and the Senior Manager with coordinating meetings, confirming tasks are completed in Salesforces, etc.
    • Provides daily operational support to Customer Operations department for assigned tasks.
    • Communicate with both internal and external customers via email and phone.

     

    Minimum Qualifications

     

    Minimum

    • High school education or equivalent and
    • 2 years’ experience in payor policies to include all areas of reimbursement, medical policy and payor appeal requirements

    Preferred

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

     

     

     

    Additional Success Factors

    • Experience using various software applications will be used, e.g., Salesforce, Word, Excel, Acrobat. 
    • Attention to detail with the ability to quickly identify trends
    • Good communication and interpersonal skills
    • Basic understanding of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles
    • Basic understanding of medical terminology
    • Self-starter / take initiative to pro-actively resolve problems
    • Strong sense of personal accountability to meet deadlines
    • Basic understanding of MS Office suite programs.
    • Basic understanding of Electronic Health Records (EHR); such as, OPS and NextGen
    • Basic knowledge to pull data and migrate into on-line document management systems such as 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.

    Our Investment in You

     

    • Competitive salary.
    • Competitive health and insurance benefits.
    • Annual target bonus or commission.
    • Paid vacation and sick time.
    • Frequent company update talks with our leadership team.

     

     

     

    Hanger, Inc. is committed to providing equal employment opportunity in all aspects of the employer-employee relationship. All conditions and privileges of employment are administered to all employees without discrimination or harassment because of race, religious creed, color, age, sex, sexual orientation, gender identity, national origin, religion, marital status, medical condition, physical or mental disability, military service, pregnancy, childbirth and related medical conditions, special disabled veteran status, or any other classification protected by federal, state, and local laws and ordinances. The Company will comply fully with all applicable state or local fair employment laws that forbid discrimination or harassment on the basis of other protected characteristics. Retaliation against any employee for filing or supporting a complaint of discrimination or harassment is prohibited.​​

     

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