The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

Introduction

Do you have the career opportunities as a(an) Research Examiner WFH you want with your current employer? We have an exciting opportunity for you to join Work from Home which is part of the nation's leading provider of healthcare services, HCA Healthcare.

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.

Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Research Examiner WFH where your passion for creating positive patient interactions are valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Job Summary and Qualifications

GENERAL SUMMARY OF DUTIES:

DUTIES INCLUDE BUT NOT LIMITED TO:

1. Perform concurrent and retrospective review of paper & electronic claims processed and office services fulfillment team Optical Character Recognition (OCR), clearinghouse and mail interface vendor activities’ performance at all levels.

2. Review monthly routine random sampling audit of examiner processed claim(s) for accuracy and provides feedback to the examiner.

3. Review monthly support team workflows to ensure regulatory timeliness, distribution and accuracy guidelines are met.

4. Report monthly metric volume, procedural and financial accuracy on a recurring schedule to claim management.

5. Identify possible systemic issue, report to IT and claim leadership for appropriate corrective action and to maintain application integrity.

6. Identify possible examiner error and notify claim management for performance review and apply corrective action if necessary.

7. Weekly review of high-dollar claims.

8. Review and analyze audit data, including trend results with recommendation of process changes, refresher training and system enhancements to improve systemic examiner and system quality/performance.

9. Maintain working knowledge of policies and procedures for standard work processes in claims & support departments.

10. Perform focus audit as necessary.

11. Occasionally process claims to maintain skills

12. Perform other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES MINIMUM REQUIREMENTS:

• Subject Matter Expert (SME) in medical claims processing at health plan payor, Managed Services Organization (MSO), Health Maintenance Organization (HMO) and/or Independent Practice Association (IPA) organization
• Hands-on knowledge and functional understanding of medical claims billing, processing, terminology, diagnosis and procedures.
• Working knowledge of Commercial, Medicare and HMO lines of business processes
• Ability to effectively review, interpret and apply Division of Financial Responsibility (DOFR) requirements.
• Personal laptop and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, PowerPoint.
• Technical proficiency in database and worksheet program applications.
• Identify ICD-10, CPT-4, HCPCS, Revenue Codes, UB-04 and CMS-1500 forms
• Work cooperatively and interact with auditors, examiners, support team and management positively.
• Adapt to changes in requirements/priorities on a daily basis.
• Produce logs and reports as required.
• Effectively communicate orally and in writing.
• Analyze and evaluate information in an accurate manner.
• Interpret policies & procedures.
• Work independently using sound judgement in ambiguous and defined concepts.
• Exercise outstanding time management capabilities.
• Accept accountability of all tasks and results.

EDUCATION: High School Diploma required. College degree preferred.

EXPERIENCE:

• 4 – 5 years’ experience as a Senior claim examiner in a managed care environment required
• Customer service skills required

• Prior medical claim auditing experience preferred

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 Healthcare's 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.

"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Research Examiner WFH opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

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.