Priority Claims Analyst II

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.

Primary responsibilities for the Priority Claims Analyst II - Remote include the management and facilitation of the Centers for Medicare and Medicaid Services (CMS) or private payors� financials to ensure compliance, improve performance, and reimbursement rates; as well as, maintaining exceptional support and communication with clinics, employees, and management. Other responsibilities may include liaison roles, claim submissions and various other types of processing. � Principal Duties and Responsibilities (Essential Functions): - Perform internal and external review of data, files or medical charts to ensure that all required documentation is in compliance with guidelines; such as, CMS and other medical policies - Prepare assessments based upon facts, document the company�s position, and obtain all documents to support the analysis - Consult with management, clinicians, physicians and physician staff (if acceptable within the Region), as needed, on documentation issues, clinical deficiencies, new trends, and other regulatory issues potentially require internal policy changes - Develop and manage relationships with colleagues in a professional manner - Update tracking and billing systems accordingly - Attend department meetings, discuss unique audit findings, and present recommendations - Responsible for conducting special projects, which may include reconciling and reviewing medical necessity - Responsible for program administration for the following type of initiatives: CMS audit, claim processing liaison, complex claims processing review, and other priority claims areas

Knowledge and Skill:

• Works well under pressure
• Attention to detail with the ability to quickly identify trends
• Good communication and interpersonal skills
• Basic working knowledge of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles
• Basic knowledge of medical terminology
• Self-starter and take the initiative to proactively solve/investigate problem areas
• Ability to multi-task
• Personal accountability and meet deadlines consistently
• Demonstrates basic knowledge of MS Office suite programs
• Basic knowledge of Electronic Health Record systems; such as, OPS and NextGen
• Ability to pull data, scan, and migrate into OnBase
• Demonstrate high ethical standards regarding confidential patient and billing information; ensuring compliance with relevant laws, including HIPAA requirements, regulations and established Hanger policies and procedures

Job Complexity:

Works on problems of moderate scope where analysis of situations or data requires a review of a variety of factors. Exercises judgment within defined procedures and practices to determine appropriate action. Builds productive internal/external working relationships.

Supervision Received and Exercised:

Normally receives general instructions on routine work, detailed instructions on new projects or assignments.

 Experience and Education:

Minimum

• Bachelor’s degree is required; 4 years of practical experience in lieu of education is acceptable
• Minimum 3 years of experience to include at least one of the following areas: Medicare, reimbursement, medical policy or payor appeal requirements.

Preferred

• Licensed Medicare auditor or Certified Medical Audit Specialist
• Para-Legal background

Environmental Factors:

Work environment characteristics, and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee will regularly be required to sit, walk and stand; occasionally bend or twist; regularly talk and hear, both in person and by telephone; use hands to operate standard office equipment; reach with hands and arms (to include reaching overhead); and lift up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus. The employee must be capable of functioning effectively under moderate or high stress levels due to work subject to time constraints, responsibility to deliver, and the need for rapid adaptation within a dynamic work environment.  The employee will be responsible for maintaining a safe, clean and orderly work environment.   The employee may be exposed to weather conditions prevalent at the time. The noise level in the work environment is usually moderate.

Some travel via automobile, airplane and other public transportation may be required.  The employee must have, or be eligible to obtain, a valid driver’s license and driving record within the standards outlined wtihin Hanger’s Motor Vehicle Safety Policy and Procedures. 

Critical features of this job are described under the headings above.  These features may be subject to change at any time due to reasonable accommodation or other reason.

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 fully 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.​​

• 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.

#LI-Remote

Pay range of $27.88 to $41.83 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
• Flexible Work Schedules and Part-time Opportunities
• Generous Employee Referral Bonus Program
• Mentorship Programs- Mentor and Mentee
• Student Loan Repayment Assistance by Location
• Relocation Assistance
• Regional & National traveling CPO/CO/CP opportunities
• Volunteering for Local and National events such as Hanger’s BAKA Bootcamp and EmpowerFest

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