Priority Claims Specialist III
Hanger, Inc.
Priority Claims Specialist III
Hanger, Inc.
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteSalary
💰 $20 - $29 per hour
Job Level
Mid-LevelSenior
About the role
- Review complex claims, patient records and hospital and physician billing practices to identify discrepancies or errors in Medicare payments
- Retrieve and properly identify documents from Revenue Cycle Management (RCM) system and update tracking and billing systems
- Perform internal and external data, files, or medical chart reviews to ensure codes billed are supported and comply with CMS guidelines and medical policies
- Complete, review, and research deficiencies and consult with physicians/clinicians and staff on documentation and regulatory issues
- Develop and manage relationships with colleagues and report anomalies and trends to Supervisor
- Conduct special projects, reconcile and review medical necessity, and prepare spreadsheets and summary reports
- Prepare complex claims reimbursement submissions in managed care environment and assess risk of denial, audit, or retraction
- Advocate and support clinic administration on reimbursement and managed care, maintain relationships with customers and insurance organizations
- Provide training to field staff on reimbursement issues and process complex claims accurately
Requirements
- Minimum High school education or equivalent
- 4 years of related experience in payor policies including reimbursement, medical policy and payor appeal requirements
- Preferred: Bachelor’s degree
- Preferred: Licensed Medicare auditor or Certified Medical Audit Specialist
- Attention to detail with ability to quickly identify trends
- Strong communication and interpersonal skills
- Working knowledge of Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles
- Working knowledge of medical terminology
- Self-starter; proactive problem resolution
- Ability to multi-task and 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
- Demonstrated high ethical standards regarding confidential patient and billing information
- Must be able to work remotely in the United States (Telecommute (U.S.))
