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Claims Trainer - Healthcare (Training Administrator)
The Training Administrator is responsible for developing and executing a training program that mitigate any potential financial or legal risks as it relates to claims processing, provider dispute resolution, and claims quality assurance. The incumbent maintains all tools such as claims policies and procedures, job aids, and claims desktops for a large enterprise claims operation and ensures the department stays compliant with all regulatory processes and CalOptima business objectives. The incumbent will deliver training in a variety of classroom setting to learners with various backgrounds and skill levels. Provides specific feedback and training to examiners that require one-on-one training and provide general trend information to management.
- Designs, develops and delivers training via traditional and virtual classroom methods including; one-on-one sessions, job aids, participant/instructor guides and/or any combination thereof.
- Develops, administers, and analyzes questionnaires, surveys, practice exercises, and pre/post-assessments to assess the effectiveness of the training programs.
- Performs thorough review of CMS and DHCS processing guidelines. Employs Rapid Course Development methodologies to quickly meet CMS and DHCS processing updates or changes.
- Collaborates with management and team to monitor and create action plans based on training results.
- Partners with the claims audit team to conduct audits of new hires to insure understanding and application of guidelines until acceptable accuracy is attained and the new hire is released.
- Identifies needs assessments and training opportunities which includes establishing training and development plans based on audit results, health plan audit findings and management input.
- Performs root cause analysis on audit errors and determine training needs if applicable.
- Updates and maintains trainee performance scores. Works closely with management on trainee performance metrics and roster updates.
- Serves as the subject matter expert and resource for CMS and/or DHCS claims processing regulatory guidelines.
- Develops training knowledge base tools or reporting and trending for management as needed.
- Researches and distributes weekly processing alerts and processing tips based on quality trend reports.
- Develops and updates policies and procedures and desk level procedures to provide clarity as applicable.
- Other projects and duties as assigned.
Experience & Education:
- Bachelor’s degree in Healthcare or any combination of education and claims training experience which would provide an equivalent background.
- 3+ years of experience in training, content creation and delivery role required.
- Experience in the development and delivery of training for large initiatives.
- CMS and/or DHCS claims processing guidelines or regulations required.
- Terminology, CPT, Revenue Codes, ICD10, HCPCS codes as it relates to claims processing adjudication.
- Core claims processing systems and healthcare authorization systems.
- Adult learning concepts which include reading, writing, overserving and hand-on exercises.
- Software experience in Excel, Word and knowledge of Access and PowerPoint required.