Claims Operations Lead

* This role prefers candidates local to California and/or Pacific Time Zone*

Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Claims Operations Lead today with Work from Home.

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:

• 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.

Come join our team as a Claims Operations Lead. We care for our community! Just last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations. Apply Today!

Job Summary and Qualifications

The Claims Operations Lead position’s primary function is to support the unit in work distribution and accurate adjudication of claims. In addition, the position is responsible for training and providing direction to Claims Examiners and Audit Research personnel.

DUTIES INCLUDE BUT NOT LIMITED TO:

Adjudicates and distributes work assignments including complex claims, resolving all system edits and audits for hard copy and electronic claims in accordance with policy.

Works directly with Health Plans and external vendors to resolve claims issues.

Coordinates necessary workflows for verification of referral and payment on non- participating provider claims.

Resolves provider and eligibility issues relating to received claims.

Processes high dollar claims in accordance with procedures.

Identifies potential system programming issues and assists with resolution.

Performs any necessary system testing for implementation of new processes within the -400.

Provides technical support and training for claims processors and claims examiners.

Provides staff with any and all internal communications regarding workflows/changes.

Recognizes and appropriately routes claims for carved out services according to health plan contracts.

Understands health plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and processes claims using this knowledge.

Understands general ledger accounts and posting of claims information to the appropriate accounts.

Generates daily reports, assigns work, maintains weekly on hand reports

Monitors performance and claims processing times to ensure compliance with performance standards.

Perform other duties as assigned

KNOWLEDGE, SKILLS AND ABILITIES: This position requires the following minimum requirements:

Ability to communicate well with supervisors and co-workers.

Knowledge of medical terminology.

Knowledge of Department of Managed Health Care (DMHC), and Centers for Medicare and Medicaid Services (CMS) requirements.

Knowledge of ICD-9, ICD-10, CPT, HCPCS, and revenue coding.

Ability to analyze claim issues and “trouble shoot” claims problems.

Ability to act as a resource and/or trainer for claims processors and claims examiners.

Technical competence with claims processing software.

Supervisory skills in claims processing.

Ability to work in a high volume, production-oriented environment.

Detail oriented with an ability to sit for extended periods of time.

Ability to work under demanding performance standards for production and quality.

Ability to understand, implement and train complex claim procedures.

EDUCATION:

High school diploma or equivalent.

EXPERIENCE:

Three years of experience processing claims, with at least two years of claims examiner experience.

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.

"The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- 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 Claims Operations Lead 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.