Title: Research Examiner
WFH
Location: Nashville United States
Job Description:
Description
Introduction
Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Research Examiner WFH with Work from Home you can be a part of an organization that is devoted to giving back!
Benefits
Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
Free counseling services and resources for emotional, physical and financial wellbeing
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
Employee Stock Purchase Plan with 10% off HCA Healthcare stock
Family support through fertility and family building benefits with Progyny and adoption assistance.
Referral services for child, elder and pet care, home and auto repair, event planning and more
Consumer discounts through Abenity and Consumer Discounts
Retirement readiness, rollover assistance services and preferred banking partnerships
Education assistance (tuition, student loan, certification support, dependent scholarships)
Colleague recognition program
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
Would you like to unlock your potential with a leading healthcare provider dedicated to the growth and development of our colleagues? Join the Work from Home family! We will give you the tools and resources you need to succeed in our organization. We are looking for an enthusiastic Research Examiner WFH to help us reach our goals. Unlock your potential!
Job Summary and Qualifications
The Research Examiner is to ensure correct adjudication of all claims for PPMSI contracted plans.
What you will do:
Adjudicate recalculations, resolving all system edits and audits for hardcopy and electronic claims.
Handle Case Log adjustment requests and resolve claims issues. Identify root cause for errors and work with appropriate departments for on-going resolution.
Resolve provider and eligibility issues relating to received claims.
Identify potential system programming issues and report issues to Manager.
Provide technical support and training for claims examiners.
Understand Plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and process claims accordingly.
Complete excel spreadsheets for project reconciliation.
Where needed send written explanation to provider following completion of claim research.
Complete Provider Dispute Resolution process in accordance with AB1455.
Perform other duties as assigned.
What you will need:
This position requires the following minimum requirements:
Ability to communicate well with supervisors and co-workers
Ability to analyze claim issues and "trouble shoot" claims problems
Ability to work in high volume, production oriented environment
Detail oriented with an ability to sit for extended period of time
Ability to act as a resource and/or trainer for claims processors
Ability to work under demanding performance standards for production and quality
Technical competence with claims processing software
Ability to understand and implement complex claims procedures
Team player, ability to work on several projects at once
Medical Terminology
Requirements:
Knowledge of DMHC, CMS, and NCQA requirements
Proficient in Microsoft Word and Excel for Windows
High school diploma or equivalent required
Two (2) years of experience processing claims, with at least one year of claims examiner experience required
Knowledge of ICD-9, CPT, HCPC and Revenue Coding required
Physician Services Group is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare's graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcares commitment to the care and improvement of human life.
HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
Be a part of an organization that invests in you! We are reviewing applications for our Research Examiner WFH opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
