Priority Claims Specialist IV @ Hanger, Inc.
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About Hanger, Inc.
Empowering Human Potential, Hanger, Inc. is the world's premier provider of orthotic and prosthetic services and products. With 160 years of clinical excellence, they lead with advanced O&P solutions and superior patient care.
Job Overview
The Priority Claims Specialist IV role is remote and focuses on reviewing complex claims, patient records, and billing practices. You will identify discrepancies or errors in Medicare payments, support communication with clinics, employees, and management, and ensure compliance with CMS guidelines.
Your Impact
- Medicare Audit Specialist: Retrieve and manage RCM documents; perform reviews of data, medical charts, and coding accuracy.
- Reimbursement Specialist: Prepare and submit complex claims, assess risks, and support reimbursement programs.
- Collaboration: Consult with physicians/clinicians and provide training to field staff.
- Reporting: Report anomalies and trends to your supervisor promptly.
- Project Work: Conduct special projects including data reconciliation and outcome summaries.
Knowledge and Skills
- Excellent communication and interpersonal skills
- Strong analytical abilities to identify trends
- High knowledge of Medicare audits, appeals, reimbursement, LCDs, and policy articles
- Proficient with medical terminology
- Experience with MS Office, EHR systems (OPS, NextGen) and data migration tools like OnBase
Supervision and Qualifications
This role involves determining methods on new assignments and may involve informal team leadership. A minimum of a high school education or equivalent along with 6 years’ experience in reimbursement and medical policy is required. A bachelor’s degree and certifications such as Licensed Medicare Auditor or Certified Medical Audit Specialist are preferred.
Additional Success Factors
- Integrity and transparency in all relationships
- Patient-centered focus
- Collaboration and constructive dialogue
- Innovation and adaptability
- Focus on superior outcomes and process calibration
Compensation & Benefits
Pay range: $18.50 to $27.88 per hour + benefits + annual bonus up to 5% of base pay. Benefits include competitive compensation, paid holidays, PTO, medical/dental/vision, 401k, parental leave, flexible schedules, referral bonuses, mentorship programs, student loan repayment assistance, relocation assistance, and opportunities for regional and national travel.
Equal Employment Opportunity
Hanger, Inc. provides equal employment opportunities and administers all employment conditions without discrimination.
Key skills/competency
Priority Claims Specialist IV, Medicare audit, reimbursement, claims review, RCM, compliance, billing, documentation, EHR, MS Office, OnBase
How to Get Hired at Hanger, Inc.
🎯 Tips for Getting Hired
- Customize Your Resume: Highlight Medicare audit and reimbursement expertise.
- Research Hanger, Inc.'s Culture: Study their clinical excellence and innovation.
- Emphasize Compliance Experience: Detail knowledge of CMS guidelines.
- Prepare for Behavioral Questions: Focus on teamwork and problem-solving.