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. 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.
Could This Be For You?:The Primary responsibilities for Priority Claims Specialist II - Remote 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
Your Impact:Knowledge and Skill:
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.
Minimum Qualifications:Experience and Education:
Minimum
Preferred
Additional Success Factors:
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Pay range of $17.75 to $25.94 per hour + 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.
Our Investment in You:
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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