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.
Primary responsibilities includes reviewing complex claims, patient records and hospital and physician billing practices and identifying any discrepancies or errors in payments made to Medicare providers; while maintaining support and communication with Clinics, employees, and management alike.
Principal Duties and Responsibilities (Essential Functions): � Medicare Audit Specialist: - 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. � Reimbursement Specialist: - 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
Knowledge and Skill:
Job Complexity:
Works on assignments requiring considerable judgment and initiative. Understands implications of work and makes recommendations for solutions.
Supervision Received and Exercised:
Determines methods and procedures on new assignments. May be informal team leader.
Experience and Education:
Minimum
Preferred
Environmental Factors:
Work environment characteristics, and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee will regularly be required to sit, walk and stand; occasionally bend or twist; regularly talk and hear, both in person and by telephone; use hands to operate standard office equipment; reach with hands and arms (to include reaching overhead); and lift up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus. The employee must be capable of functioning effectively under moderate or high stress levels due to work subject to time constraints, responsibility to deliver, and the need for rapid adaptation within a dynamic work environment. The employee will be responsible for maintaining a safe, clean and orderly work environment. The employee may be exposed to weather conditions prevalent at the time. The noise level in the work environment is usually moderate.
Some travel via automobile, airplane and other public transportation may be required. The employee must have, or be eligible to obtain, a valid driver’s license and driving record within the standards outlined wtihin Hanger’s Motor Vehicle Safety Policy and Procedures.
Critical features of this job are described under the headings above. These features may be subject to change at any time due to reasonable accommodation or other reason.
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.
Pay range of $20.48- $30.67 per hour + bonus+ commission+ benefits. This pay range is posted to comply with wage transparency laws. Hanger salary ranges vary based on skill, ability, knowledge, geographic location and other variables.
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 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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