Responsibilities: * Develops training material, assessment tools and concepts for instructor led classroom training for new hires as well as development of current employees * Conduct group and one on one training as required * Identifies needs assessments and training opportunities which includes establishing training and development plans based on audit results, health plan audit findings and management input. * Perform root cause analysis on audit errors and determine training needs if applicable * Conducts audits of trainees work to insure understanding and application of guidelines until acceptable accepted accuracy is attained and trainee is released * Learns and maintains thorough working knowledge of all pertinent processes, policies, and procedures within the department and stays abreast of all changes * Develop and update P&P’s and desk level procedures to provide clarity and update to process changes * Project management of specialized projects or programs related to Claims
REQUIRED SKILLS: Experience * 5 years claims processing and PDR/Reopen experience. * At least 3 years’ experience as a trainer in a Claims and Compliance environment. * Excellent written and verbal communication skills * Strong computer application skills including Microsoft Office * Ability to organize and prioritize work to meet deadlines * Analytic ability, good judgement, initiative and problem solving ability * In depth knowledge of claims processing, system configuration, edits, adjustment adjudication and claims department processes * Knowledge of Medicare Advantage and DMHC regulations * Knowledge of CPT/HCPCS, ICD-10 coding and Medical Terminology
Education * College Degree preferred or comparable experience. * At least 3 years prior experience as a trainer in Claims and Compliance environment.