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Hanger, Inc. · 1 day ago

Priority Claims Specialist III

United States

Full-time

Remote

Mid Level

$19.62/hr - $29.42/hr

4+ years exp

Hanger, Inc. is the world's premier provider of orthotic and prosthetic services and products. They are seeking a Priority Claims Specialist III to review complex claims, identify discrepancies in payments made to Medicare providers, and maintain communication with clinics and management.

Health CareHospitalMedical Device

H1B Sponsor Likely

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

Qualification

Medicare audit knowledgeClaims reimbursement expertiseMedical terminologyElectronic Health Records (EHR)MS Office proficiencyMulti-taskAttention to detailCommunication skillsInterpersonal skillsSelf-starter

Required

High school education or equivalent

4 years of related 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

Attention to detail with the ability to quickly identify trends

Strong communication and interpersonal skills

Working knowledge of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles

Working knowledge of medical terminology

Self-starter / take initiative to proactively resolve problems

Ability to multi-task

Strong sense of personal accountability to meet deadlines

Working knowledge of MS Office suite programs

Working knowledge of Electronic Health Records (EHR); such as, OPS and NextGen

Demonstrated ability to pull data and migrate into online records 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

Benefits

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

Company

Hanger, Inc.

Glassdoor3.5

Headquartered in Austin, Texas, Hanger, Inc. is a leading provider of orthotic and prosthetic (O&P) patient care services and products.

Founded in 1861

Austin, Texas, USA

5001-10000 employees

https://corporate.hanger.com/

H1B Sponsorship

Hanger, Inc. has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (2)

2024 (1)

2022 (1)