Claims Trainer

Job Description

Summary:

Under the supervision of the Claims Department Manager, the Claims Trainer develops, implements and facilitates inter and intra departmental claims training programs as well as designs and maintains departmental policies and procedures. This role is responsible for training new hires, ongoing training for existing staff, and monitoring and reporting training effectiveness. The Claims Trainer will assist with establishment of initiatives to structure and standardize claims processing, claims auto adjudication and monitor claim inventory. This role will assist the Claims Manager with regulatory claim audits, escalated claims, and will act as the claims subject matter expert. The Claims Trainer is the primary claims end tester and will assist the configuration department as needed and is responsible for full claims system upgrade testing.

• Execute the development, implementation and revisions of claims training curriculum and education initiatives. This includes but is not limited to working with Claims Managers and Supervisors to identify gaps in workflow, creation of policies and procedures as reflected in the claims training manuals and scheduling and conducting department training.

• Communicate &distribute changes to department documents, identify & resolve issues, and implement new processes.

• Complete needed assessments of the Claims Operation staff and department by analyzing auditing reports/corrective action results and trends to effectively create or modify training to meet individual and departmental needs and goals.

• Assess trainee performance and provide appropriate and timely feedback to claims managers and supervisors.

• Primary Claims End User Tester lead for Claims Operations in the development, testing and implementation of new and/or revised system enhancements to ensure effective and efficient claims processing by translating Claims Operation business requirements, user stories to test cases, developing testing scripts by performing manual testing for Benefit Configuration, Facility Contracts (new/revised) by conducting positive and negative testing.

• Collaborate with the Claims Managers and Supervisors to create and implement metrics aligned with departmental/individual training needs.

• Prepare monthly reports on Claims Operation staff performance metrics/assessments that can lead to actionable improvements in the department operations and staff performance.

• Perform research and assist with projects as needed.

• Provides recommendations to management for procedural improvements to support the department.

• Assists in developing training material by working with claims staff, as well as team members from other departments within the organization, to develop training materials to improve existing training resources.

• Provide excellent customer service to internal and external customers

• Assists with regulatory claim audits.

• Must be able to work flexible work schedule to ensure deadlines and business needs are satisfied.

• Other duties as assigned by management

• Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals

• Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

Requirements:

• Bachelor's degree preferred or equivalent job-related experience

• Thorough knowledge of medical terminology, CPT, HCPCS, ICD-10, Revenue Codes, CMS-1500, and CMS-1450 claim forms

• Excellent written, verbal, and interpersonal communication skills required

• Spreadsheet and database skills required

• Proficient in Microsoft Office

• Ability to organize and prioritize work to meet deadlines

• Good judgment, initiative, and problem-solving abilities

• Minimum of at least three (3) years' experience in medical claims processing and adjustments at a healthcare organization

• Medical claims training experience highly desirable

• Experience with managed care, Medicare, Health Exchange, and Tricare

Work Type:

Full Time

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Claims Trainer

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