Priority Claims Specialist III

Priority Claims Specialist III

Job :

• # Positions: 1
• Job Location:
  
  US
• Telecommute:
  Telecommute (U.S.) Position
• FT/PT:
  Full-Time
• Category:
  Medical Office Professionals

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.

The Priority Claims Specialist III - Remote will ensure payment for services provided is accurate, timely and fully documented. Provide efficient cash collection through excellent reimbursement practices while ensuring compliance with relevant laws, regulations and established Hanger policies and compliance programs. Provides strict adherence to adjustment, refund and write-off policies/procedures as outlined in Hanger Clinic Standard Operating Procedures. Maintain exceptional support and communication with all partners, internal and external.

This is a high-dollar medical collections role operating within a Centralized Revenue Cycle Team. This is a full time, remote opportunity. Schedule will be Monday - Friday day shift

Responsibilities for the role will include:

• Maintain a working knowledge and understanding of DMEOPS CPT and ICD-10 codes.
• 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 submit corrected claims to 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.
• Resolve 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.

Minimum

• High school education or equivalent
• 5+ years of related experience to include at least one of the following areas:
  Insurance reimbursement, medical policy, payor appeal requirements or patient collection laws.
• Experience in a medical office.

Preferred

• Associate's degree.
• Experience with Next Gen and/or OnBase.
• Licensed Medicare auditor or Certified Medical Audit Specialist

Knowledge and Skill:

• Attention to detail with the ability to quickly identify trends.
• Strong communication and interpersonal skills.
• Working knowledge of the Medicare audit, 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 Next Gen.
• 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.

• Strong interpersonal, oral (including telephone) and written communication skills, including the ability to follow written and verbal directions.
• Works well under pressure.
• Attention to detail with the ability to quickly identify trends.
• 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…