Research Examiner

at  HCA Healthcare

Hourly Wage Estimate: $23.00 - $33.24 / hour
Learn more about the benefits offered for this job.
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.

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 HCA Healthcare family! We will give you the tools and resources you need to succeed in our organization. We are looking for an enthusiastic Research Examiner to help us reach our goals. Unlock your potential!

JOB SUMMARY AND QUALIFICATIONS

The Research Examiner’s primary function is to ensure correct adjudication of all claims for PPMSI contracted plans.

• 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:

• 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
• 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 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.
“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 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