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
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
College Degree preferred or comparable experience.
At least 3 years prior experience as a trainer in Claims and Compliance environment.
Internal Number: MEM003190
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.