Research Examiner Wfh ($21.95 - $31.84 / Hour)

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Description

Hourly Wage Estimate: $21.95 - $31.84 / 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.

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:

• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• 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.
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Consumer discounts through Abenity and Consumer Discounts
• 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 Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• 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.
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Referral services for child, elder and pet care, home and auto repair, event planning and more

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

Duties Include But Not Limited To

• Handle Case Log adjustment requests and resolve claims issues. Identify root cause for errors and work with appropriate departments for on-going resolution.
• Understand Plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and process claims accordingly.
• Perform other duties as assigned.
• Provide technical support and training for claims examiners.
• Complete Provider Dispute Resolution process in accordance with AB1455.
• Complete excel spreadsheets for project reconciliation.
• Where needed send written explanation to provider following completion of claim research.
• Resolve provider and eligibility issues relating to received claims.
• Adjudicate recalculations, resolving all system edits and audits for hardcopy and electronic claims.
• Identify potential system programming issues and report issues to Manager.

What Qualifications You Will Need

• High School Graduate / GED
• This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved).
• 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
• High School Graduate / GED

No Travel Travel Required

2 years experi