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Priority Claims Specialist III

Hanger, Inc.
Remote, USA
Full-time
Mid · 4+ years experience
Remote
USD 18-26 hourly / hour
Discovered 3 weeks ago
NextGenOnBaseElectronic Health Records (EHR)OPS

Full Job Posting

Responsibilities for the role will include

  • 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.
  • Maintain a working knowledge and understanding of DMEOPS CPT and ICD-10 codes.
  • Experience and Education:
  • Minimum
  • 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.
  • Preferred
  • Experience with NextGen and/or OnBase.

Knowledge and Skill

  • 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.
  • 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.
  • The ideal candidate will also demonstrate:
  • 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.
  • Pay range of $18.00 to $26.00 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.
  • 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
  • Hanger, Inc. is committed to providing equal employment opportunity in all aspects of the employer-employee relationship. All conditions and privileges of employment are administered to all employees without discrimination or harassment because of race, religious creed, color, age, sex, sexual orientation, gender identity, national origin, religion, marital status, medical condition, physical or mental disability, military service, pregnancy, childbirth and related medical conditions, special disabled veteran status, or any other classification protected by federal, state, and local laws and ordinances. The company will comply with all applicable state or local fair employment laws that forbid discrimination or harassment on the basis of other protected characteristics. Retaliation against any employee for filing or supporting a complaint of discrimination or harassment is prohibited.
  • #ERF-HRC
  • #LI-Remote
  • #LI-BH1

Requirements

  • 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.
  • 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.
  • The ideal candidate will also demonstrate:
  • 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.
  • Pay range of $18.00 to $26.00 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.
  • 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
  • Hanger, Inc. is committed to providing equal employment opportunity in all aspects of the employer-employee relationship. All conditions and privileges of employment are administered to all employees without discrimination or harassment because of race, religious creed, color, age, sex, sexual orientation, gender identity, national origin, religion, marital status, medical condition, physical or mental disability, military service, pregnancy, childbirth and related medical conditions, special disabled veteran status, or any other classification protected by federal, state, and local laws and ordinances. The company will comply with all applicable state or local fair employment laws that forbid discrimination or harassment on the basis of other protected characteristics. Retaliation against any employee for filing or supporting a complaint of discrimination or harassment is prohibited.
  • #ERF-HRC
  • #LI-Remote
  • #LI-BH1

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