Description

　　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 (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards)

　　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

　　SUMMARY

　　Reporting to the Supervisor, Research/Audit Unit, the Auditor’s primary function is to ensure payment accuracy on all claims adjudication.

　　DUTIES AND ESSENTAIL JOB FUNCTIONS

　　Performs routine random sampling audits of all claims adjudication and provides feedback examiner.

　　Identifies system versus user errors and notifies appropriate responsible entitles so necessary corrective actions can be taken.

　　Recommendations process changes and system enhancements to improve overall quality/performance.

　　Reports procedural and financial accuracy on a regular schedule to Upper Management.

　　Reviews weekly payment postings prior to check runs as final QA step in payment cycle.

　　Reviews payment structure against current HMO contracts.

　　Audits the implementation of new contracts and contract changes.

　　Works closely with other departments, such as the Finance and Contract/Provider Services departments, to ensure proper implementation of contracts and correct payment to network providers.

　　Assist network physicians with payment issues.

　　Work with contracted HMOs when there is a payment discrepancy.

　　Assists in the research of any claim payment issue.

　　OTHER FUNCTIONS AND RESPONSIBILITIES

　　Perform other duties as assigned.QUALIFICATIONS

　　REQUIRED

　　High school diploma or equivalent.

　　Three years experience as a claim examiner, preferably in a managed care environment.

　　Prior auditing experiences a plus.

　　A team player with excellent organizational and strong communication skills.

　　Possesses a technical proficiency in PC applications to include word processing, database, and worksheet programs.

　　Training in medical coding practices necessary.

　　REQUIRED LICENSES/CERTIFICATIONS

　　N/A

　　PREFERRED

　　Pays close attention to detail.

　　Able to prioritize duties effectively.

　　Able to understand basic contractual documents for interpretive purposes.

　　PHYSICAL REQUIREMENT/WORK ENVIRONMENT

　　The physical demands and work environment 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.

　　Work is primarily sedentary in nature, no special physical demands are required.

　　High School Graduate / GEDNo Travel Required

　　2 years experience Required Years of Experience

　　Physician Services Group (https://careers.hcahealthcare.com/pages/physician-services) 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.