Claims Auditor

DescriptionHourly Wage Estimate: 29.66 - 43.01 / hourLearn 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.• Qualified candidates must reside in the San Jose, CA market area*Do you want to join an organization that invests in you as a Claim Auditor? 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.BenefitsHCA, 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 BenefitsNote: 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 Claim Auditor like you to be a part of our team.Job Summary and QualificationsThe Claims Auditor will serve as a Subject Matter Expert (SME) in medical claims processing at health plan payor, MSO, HMO, and IPA organizations with the primary function 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:• 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.• Review routine random sampling audit of examiner processed claim(s) for accuracy and provides feedback to the examiner.• Review support team workflows to ensure regulatory timeliness, distribution and accuracy guidelines are met.• Report metric volume, procedural and financial accuracy on a recurring schedule to claim management.• Identify root cause of system and/or examiner errors, report to claim leadership for appropriate corrective action.• Partner with claim management on performance management recommendation.• Weekly review of high-dollar claims.• 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 you will need:• Highschool diploma required; Bachelors degree preferred• 4 – 5 years’ experience as a Senior Claim Examiner in a managed care environment, required• Hands-on knowledge and functional understanding of medical claims billing, processing, terminology, diagnosis and procedures.• Technical proficiency: Microsoft Office Suite applications, including Outlook, Word, Excel, PowerPoint. Identify• Solid knowledge of ICD-10, CPT-4, HCPCS, Revenue Codes, UB-04 and CMS-1500 forms• Customer service skills requiredSupporting 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.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."Good people beget good people."- Dr. Thomas Frist, Sr.HCA Healthcare Co-FounderWe are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Claim Auditor 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.