Priority Claims Specialist II

• 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.

We are seeking a Priority Claims Specialist II - Remote.  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:

• 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 proactively 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 online document management systems such as OnBase;
• Demonstrate high ethical standards regarding confidential patient and billing information

Job Complexity:

Works on assignments that are semi-routine in nature but recognizes the need for occasional deviation from accepted practice.

Supervision Received and Exercised:

Normally follows established procedures on routine work, requires instructions only on new assignments.

Experience and Education:

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

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.

• 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.

#LI-Remote

Pay range of $17.75 to $22.00 annual salary + annual bonus: up to 5% of base pay depending on bonus criteria.  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.  

• 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

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.

#ERF-HRC