Senior Claims Examiner

Description * This role prefers candidates local to California and/or Pacific Time Zone* Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family Jump-start your career as a Senior Claims Examiner today with Work from Home. 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. Come join our team as a Senior Claims Examiner. We care for our community Just last year, HCA Healthcare and our colleagues donated 13.8 million dollars to charitable organizations. Apply Today Job Summary and Qualifications The Senior Claims Examiner primary function is to ensure correct adjudication of all complex claims for SCCIPA contracted plans. DUTIES INCLUDE BUT NOT LIMITED TO: Adjudicate all types of claims, resolving all system edits and audits for hardcopy and electronic claims. Resolve provider and eligibility issues relating to received claims. Generate emergency reports/authorizations for all received claims which lack prior authorization. Adjudicate third party liability and coordination of benefit claims in accordance with policy. Review stop loss reports and identify members who are nearing reinsurance levels. Identify potential system programming issues and reports issues to supervisor. Provide technical support and training for claims processors. Recognize and appropriately route claims for carved out services according to Plan contracts. Understand Plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and processes claims using this knowledge. Understand general ledger accounts posting of claims information to the appropriate accounts. Work with Customer Service and Provider Services to assist on large claim projects and adjustments. Assist with benefit/plan interpretation with customer via the cut-log system when necessary. Adjust complex claims and assist other examiners. Perform other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: 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 a high volume, production-oriented environment Detail oriented with an ability to sit for extended period of time 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 Medical terminology Knowledge of HEDIS, DOC, HCFA and NCQA requirements Ability to act as a resource and /or trainer for claims processors EDUCATION: High school diploma or equivalent required EXPERIENCE: Three to Five years of experience processing regular and complex claims 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. "The great hospitals will always put the patient and the patients family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- 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 Senior Claims Examiner 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. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.