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Hanger, Inc. · 11 hours ago

Priority Claims Specialist III

United States

Full-time

Remote

Senior Level

$20/hr - $25/hr

5+ years exp

Hanger, Inc. is the world's premier provider of orthotic and prosthetic services and products. The Priority Claims Specialist III will ensure accurate and timely payment for services provided, while maintaining compliance with relevant laws and regulations, and will be responsible for managing complex claims and denials.

Health CareHospitalMedical Device

Responsibilities

Maintain a working knowledge and understanding of DMEOPS CPT and ICD-10 codes

Utilize the company billing and collections system to identify and resolve any claims that have been unpaid, short paid and/or denied

Review EOB's and other correspondence from insurance companies for correct reimbursement according to rules and regulations and contract terms

Follow up with insurance companies by online portal, phone, email and/or fax

Identify billing errors and submitted corrected claims insurance carriers

Provide timely and accurate follow up on accounts until they are resolved

File and follow up on appeals and disputes

Communicate identified AR issues that may cause payment delays or write offs to management

Document all findings with clear and concise detail

Research insurance guidelines and manuals for additional information

Perform adjustments in the system as needed

Submit medical records upon request

Resolves outstanding accounts receivable problems. Respond to and resolve inquiries from customers or external collection resources

Primary focus is on complex denials and appeals

Review, monitor and resolve assigned encounters and all assigned reports

Identify issues attributing to account delinquency and discuss them with management as needed

Provide timely follow-up on all tasks

Effective communication with Patient Care Clinics related to collection efforts

Complete, review, and research any deficiency to ensure that any deficiency is properly addressed and resolved

Qualification

Insurance reimbursementMedical policyPayor appeal requirementsAttention to detailNextGenOnBaseMedical terminologyElectronic Health RecordsMulti-taskingCommunication skillsInterpersonal skillsSelf-starterOrganizational skills

Required

High school education or equivalent

5+ years of related experience to include at least one of the following areas: Insurance reimbursement, medical policy, payor appeal requirements or patient collection laws

Experience in a medical office

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

Strong interpersonal, oral (including telephone) and written communication skills, including the ability to follow written and verbal directions

Works well under pressure

Resourceful and flexible team player who excels at building trusting relationships with patients, insurance companies and colleagues

Excellent knowledge and understanding of state, federal, regional collection and reimbursement laws, HIPAA and other medical insurance regulations and terminology (CPT, ICD-9, HCPCS, modifiers, coding, and documentation guidelines) for private payer, state and federal plans including coding, billing and reimbursement protocols

Proficient computer skills including Windows based office technologies (ex. Word, Excel, PowerPoint), e-mail and automated billing systems

Excellent organizational skills and the ability to manage multiple tasks (ex. multitasking) with a high degree of detail orientation while working in a fast-paced environment

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