Research Examiner

Job Summary

The Research Examiner ensures correct adjudication of all claims for PPMSI contracted plans. Duties include adjudicating recalculations, handling Case Log adjustments, resolving claims issues, identifying root causes, and providing technical support.

Qualifications

• Ability to communicate well with supervisors and co-workers
• Ability to analyze claim issues and troubleshoot claims problems
• Detail oriented with the ability to sit for extended periods
• Act as a resource and/or trainer for claims processors
• Work under demanding performance standards for production and quality
• Technical competence with claims processing software
• Understand and implement complex claims procedures
• Team player, able to work on multiple projects at once
• Knowledge of Medical Terminology
• Knowledge of DMHC, CMS, and NCQA requirements
• Proficient in Microsoft Word and Excel for Windows

Education and Experience

• 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

Benefits

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing

Company Information

HCA Healthcare is the nation's leading provider of healthcare services. They are experts in physician employment, practice and urgent care operations, hospitalist integration, and graduate medical education. They lead more than 1,300 physician practices and 170+ urgent care centers. They are HCA Healthcare's graduate medical education leader, providing direction for over 260 exceptional resident and fellowship programs. They focus on carrying out value-added solutions that help physicians deliver patient-centered healthcare. 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, they spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

About the Company

HCA Healthcare is committed to the care and improvement of human life. They believe that "Bricks and mortar do not make a hospital. People do." - Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder.