Priority Claims Specialist III

Employer Industry: Orthotics and Prosthetics Services

• Review complex claims, patient records, and billing practices to identify discrepancies or errors in payments to Medicare providers.
• Conduct internal and external data reviews to ensure compliance with CMS guidelines and medical policies.
• Develop and maintain professional relationships with colleagues, physicians, and regulatory staff.
• Prepare complex claims reimbursement submissions and assess claims for risk of denial or audit.
• Serve as a resource for clinic administration regarding reimbursement and managed care issues.

• High school education or equivalent.
• Minimum of 4 years of related experience in payer policies, reimbursement, and medical policy.
• Strong communication and interpersonal skills.
• Working knowledge of Medicare audit, appeals, and reimbursement processes.
• Ability to multi-task and meet deadlines with strong attention to detail.

• Bachelor’s degree.
• Licensed Medicare auditor or Certified Medical Audit Specialist.
• Experience with Electronic Health Records (EHR) systems.
• Knowledge of Local Coverage Determinations (LCDs) and policy articles.
• Proven ability to pull data and manage online records systems.

#Orthotic Prosthetic #Healthcare Careers #Remote Work #Competitive Compensation #Patient Care

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