Claims Trainer chez COMMUNITY HEALTH GROUP

Description

EEO-1: Administrative Support Workers

RESPONSIBILITIES

• Develop, maintain, and implement core training curriculum and materials, in collaboration with the Claims management team.
•  Maintain and update internal desktop resources with the latest Medi-Cal, CMS, and DHCS guidance, ensuring accurate and compliant claims processing.
•  Review monthly Medi-Cal and CMS updates (including APLs and regulatory bulletins) and communicate relevant information to Claims Management.
• Identify knowledge gaps as well as opportunities to enhance processor performance through additional training to ensure timely and accurate delivery of training programs for new and existing claims staff including cross-training.
• Work with the Claims management team to implement policies and procedures, system enhancements, and regulatory requirements.
• Develop training material and conduct training, as appropriate, to educate staff on new or revised policies and procedures.
• Work with Claims management team on the review of claims reports, provider refunds, and provider adjustments to identify training needs and trend findings.
• Conduct weekly team meetings with Analysts to communicate policy updates and provide an open forum for discussion of issues or concerns.
• Collaborate with the Claims Compliance Supervisor and Claims Supervisors to review audit results, develop corrective action plans, and implement process improvements.
• Identify system or auto-adjudication issues in collaboration with the Configuration Manager, ensuring claims are priced and processed correctly.
• Support DSNP and CSNP member reimbursement reviews to ensure payment accuracy and act as backup to the Claims Coordinator.
• Analyze ECM and Prop 56 payment trends to ensure payment accuracy and identify potential improvement opportunities.

• Provide Claims inter-departmental training to new staff throughout CHG (overview in QNXT).

Qualifications

EDUCATION                                   

• Associates degree with course work in medical terminology, CPT-4 and ICD-9 coding required.
• BA degree preferred.

EXPERIENCE/ SKILLS

• Minimum of five years experience in Medicare, Medicaid, and HMO claims processing, CPT and ICD-9 coding and medical terminology required
• Minimum two years’ experience on the development and implementation of training curriculum.
• Strong analytical skills.
• Demonstrated experience with Access and Excel.
• General knowledge of DHCS and CMS claims processing guidelines.
• Previous QNXT Claims System experience a plus.
• Excellent oral and written communication skills.
• Excellent interpersonal communication skills.

PHYSICAL REQUIREMENTS  

• Prolonged periods of sitting; frequent walking and standing.
• May be required to work evenings and/or weekends.

The above statements are intended to describe the general nature and level of work being performed.  They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

All qualified applicants will receive consideration for employment based on merit, without regard to race, color, religion, sex, national origin, disability, protected Veteran Status, or any other characteristic.