Do you have the career opportunities as a Claim Auditor 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.
Job Summary and Qualifications
The Claims Auditor primary function is to ensure examiner payment accuracy of all claims processing including analysis of support services fulfillment colleagues’ workflow and activities. Provide feedback to examiner(s) and support services personnel and conduct additional training, based on audit findings.
What you will do in this role:
- Perform concurrent and retrospective review of paper & electronic claims processed and office services fulfillment team Optical Character Recognition (OCR), clearinghouse and mail interface vendor activities’ performance at all levels.
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Review routine random sampling audit of examiner processed claim(s) for accuracy and provides feedback to the examiner.
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Review support team workflows to ensure regulatory timeliness, distribution and accuracy guidelines are met.
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Report metric volume, procedural and financial accuracy on a recurring schedule to claim management.
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Identify root cause of system and/or examiner errors, report to claim leadership for appropriate corrective action.
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Partner with claim management on performance management recommendation.
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Weekly review of high-dollar claims.
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Review and analyze audit data, including trend results with recommendation of process changes, refresher training and system enhancements to improve systemic examiner and system quality/performance.
What Qualifications you will need:
- Subject Matter Expert (SME) in medical claims processing at health plan payor, Managed Services Organization (MSO), Health Maintenance Organization (HMO) and/or Independent Practice Association (IPA) organization
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Hands-on knowledge and functional understanding of medical claims billing, processing, terminology, diagnosis and procedures.
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Working knowledge of Commercial, Medicare and HMO lines of business processes
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Ability to effectively review, interpret and apply Division of Financial Responsibility (DOFR) requirements.
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Personal laptop and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, PowerPoint.
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Technical proficiency in database and worksheet program applications.
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Identify ICD-10, CPT-4, HCPCS, Revenue Codes, UB-04 and CMS-1500 forms
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Work independently using sound judgement in ambiguous and defined concepts.
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Exercise outstanding time management capabilities.
EDUCATION:
- High School Diploma required. College degree preferred.
EXPERIENCE:
- 4 – 5 years’ experience as a Senior claim examiner in a managed care environment required
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Customer service skills required
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Prior medical claim auditing experience preferred
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:
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Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
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Wellbeing support, including free counseling and referral services
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Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
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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
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Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
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Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
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 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 Claim Auditor 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.
