Priority Claims Specialist, III

October 30

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Hanger, Inc.

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Healthcare Insurance • Biotechnology • Wellness

Hanger, Inc. is a purpose-driven company that focuses on empowering human potential by providing advanced orthotic and prosthetic services and solutions. With a commitment to clinical research, innovation, and exceptional customer service, Hanger operates 925 patient care clinics nationwide and is supported by 6,400 employees dedicated to moving lives forward. The company treats approximately one million patients annually, showcasing its significant impact in the healthcare sector.

5001 - 10000 employees

Founded 1861

⚕️ Healthcare Insurance

🧬 Biotechnology

🧘 Wellness

📋 Description

• Ensure payment for services provided is accurate, timely and fully documented • Provide efficient cash collection through excellent reimbursement practices while ensuring compliance with relevant laws, regulations and established Hanger policies and compliance programs • Maintain exceptional support and communication with all partners, internal and external • 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 to insurance carriers • Provide timely and accurate follow up on accounts until they are resolved • File and follow up on appeals and disputes • Document all findings with clear and concise detail • Research insurance guidelines and manuals for additional information • Perform adjustments in the system as needed • Resolve 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

🎯 Requirements

• Minimum 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 • Preferred Associate’s degree • Experience with NextGen and/or OnBase • 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

🏖️ Benefits

• 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