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.
Do you have the career opportunities as a Research Examiner you want with your current employer? We have an exciting opportunity for you to join Pacific Partners Management Services Inc., which is part of the nation's leading provider of healthcare services, HCA Healthcare.
PPMSI 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 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.
- Fertility and family building benefits through Progyny
- Free counseling services and resources for emotional, physical and financial wellbeing
- Family support, including adoption assistance, child and elder care resources and consumer discounts
- 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
- Employee Stock Purchase Plan
- Retirement readiness and rollover 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)
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 Research Examiner 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!
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:
- Adjudicate recalculations, resolving all system edits and audits for hardcopy and electronic claims.
- Handle Case Log adjustment requests and resolve claims issues. Identify root cause for errors and work with appropriate departments for on-going resolution.
- Resolve provider and eligibility issues relating to received claims.
- Identify potential system programming issues and report issues to Manager.
- Provide technical support and training for claims examiners.
- Understand Plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and process claims accordingly.
- Complete excel spreadsheets for project reconciliation.
- Where needed send written explanation to provider following completion of claim research.
Complete Provider Dispute Resolution process in accordance with AB1455.
- Perform other duties as assigned.
High School Graduate / GED
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
- 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).
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 Research 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 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.