Description
Introduction
*Qualified candidates must reside in the San Jose, CA market area*
Do you want to join an organization that invests in you as a Claims Examiner? At Work from Home, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years.
Benefits
HCA, 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.
You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated Claims Examiner like you to be a part of our team.
Job Summary and Qualifications
The Claims Examiner primary function is to ensure correct adjudication of all claims for SCCIPA contracted plans.
Job Responsibilities
- Adjudicate 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 and posting of claims information to the appropriate accounts.
Requirements
- High school diploma or equivalent
- Two (2) years of experience processing claims, with at least one year of claims adjudication experience required
- Knowledge of ICD-9, CPT, HCPC, and Revenue Coding
- Ability to analyze claim issues and “trouble shoot” claims problems
- Ability to work in a high volume, production-oriented environment
- Medical terminology preferred
- Knowledge of DOC and HCFA requirements preferred
Supporting HCA Healthcares 186 hospitals and 2,400+ sites of care, Physician Services plays a crucial role as the main entry point for patients looking for high-quality healthcare within the HCA Healthcare system. With a focus on meeting the needs of our patients at all access points, Physician Services is dedicated to implementing innovative, physician-driven, value-added solutions to assist physicians in providing high-quality, patient-centered care, aligning with our mission to care for and enhance 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 costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"Good people beget good people."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Claims Examiner opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!
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.
