Priority Claims Specialist III

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $18 - $26 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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Hanger, Inc.

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1861

💼 Consulting

🏭 Manufacturing

🏥 Healthcare

Consulting • Manufacturing • Healthcare

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.

📋 Description

• Ensure payment for services is accurate, timely, and fully documented • Provide efficient cash collection through compliant reimbursement practices • Identify and resolve unpaid, short-paid, and denied claims using the company billing and collections system • Review EOBs and insurance correspondence for correct reimbursement according to regulations and contract terms • Follow up with insurance companies through online portals, phone, email, and fax • Identify billing errors and submit corrected claims • Follow up on accounts until resolution • File and follow up on appeals and disputes • Communicate accounts receivable issues that may cause payment delays or write-offs to management • Document findings clearly and concisely • Research insurance guidelines and manuals • Perform system adjustments as needed • Submit medical records upon request • Resolve outstanding accounts receivable problems and inquiries from customers or external collection resources • Focus primarily on complex denials and appeals • Review, monitor, and resolve assigned encounters and reports • Identify causes of account delinquency and discuss them with management • Communicate with Patient Care Clinics regarding collection efforts • Research and resolve deficiencies • Maintain working knowledge of DMEOPS CPT and ICD-10 codes

🎯 Requirements

• 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 • Experience with NextGen and/or OnBase preferred • Attention to detail with the ability to quickly identify trends • Strong communication and interpersonal skills • Working knowledge of appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles • Working knowledge of medical terminology • Ability 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 • Ability to pull data and migrate it into online records management systems such as OnBase • High ethical standards regarding confidential patient and billing information • Strong oral, written, and telephone communication skills • Ability to work well under pressure • Resourceful and flexible team player • Knowledge of state, federal, and regional collection and reimbursement laws, HIPAA, medical insurance regulations, and terminology including CPT, ICD-9, HCPCS, modifiers, coding, and documentation guidelines • Proficient computer skills including Windows-based office technologies, email, and automated billing systems • Excellent organizational skills and ability to manage multiple detailed tasks in a fast-paced environment

🏖️ Benefits

• Annual bonus: up to 5% of base pay depending on bonus criteria • 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 • Generous Employee Referral Bonus Program • Mentorship Programs- Mentor and Mentee • Full-time remote opportunity • Monday–Friday day-shift schedule