Priority Claims Specialist I – Remote

Why Us?
With a mantra of Empowering Human Potential, Hanger, Inc. is the world’s premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, clinically differentiated programs and unsurpassed customer service. Hanger’s Patient Care segment is the largest owner and operator of O&P patient care clinics nationwide. Through its Products & Services segment, Hanger distributes branded and private label O&P devices, products and components, and provides rehabilitative solutions to the broader market. With 160 years of clinical excellence and innovation, Hanger’s vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value. Collectively, Hanger employees touch thousands of lives each day, helping people achieve new levels of mobility and freedom.

Could This Be For You?
Primary responsibilities includes reviewing complex claims, patient records and hospital and physician billing practices and identifying any discrepancies or errors in payments made to Medicare providers; while maintaining support and communication with Clinics, employees, and management alike.

Must be available to work a full 8 hour day shift.

Your Impact
As the Priority Claims Specialist you will:

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
Minimum Qualifications
To be formally considered for the role, the below requirements must be met:

High school education or equivalent
Requires up to 1 year of related experience
NextGen experience preferred

Additional Success Factors
The ideal candidate will also demonstrate:

Attention to detail with the ability to quickly identify trends
Good communication and interpersonal skills
General knowledge of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles
General knowledge of medical terminology
Self-starter / take initiative to pro-actively resolve problems
Reliable and able to meet deadlines
General knowledge of MS Office suite programs.
General knowledge of Electronic Health Records (EHR); such as, OPS and NextGen
Ability to pull data and migrate into OnBase; for OPS sites need to be scanned into On Base
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.
Our Investment in You
Employees working at least 20 hours per week are eligible for the following benefits:

Competitive Pay
Health Insurance
Dental Insurance
Vision Insurance
8 Paid Holidays per Year
Paid Vacation Time Off
Paid Sick Time Off
8 hours of paid time to volunteer in your community
Floating Holiday
Life Insurance
Medical Flex Spend Account
Dependent Care Flex Spend Account
Free employee assistance program
Full-time employees are also eligible for short-term and long-term disability insurance



Pay range of $16.00 to $23.00 per hour + annual bonus: up to 5% of base pay depending on bonus criteria. This pay range is posted to comply with wage transparency laws. Hanger salary ranges vary based on skill, ability, knowledge, geographic location and other variables.