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|Claims Trainer - Remote|
|Hours:||40 Monday to Friday 8AM to 5PM|
|Remote opportunity for Camarillo based company|
Will lead the design of the Claims training program in consultation with Claims Managers and Supervisors. Develops training materials and guides based on regulatory and internal guidelines in conjunction with company contracts, policies and procedures that apply to claims adjudication. Trains new Claims staff and recommends training topics for ongoing training of staff based on audit results. Assist with all activities related to auditing, tracking and documenting staff performance of operational processes for the Claims department. With an emphasis on ensuring claims data and other work output is accurate. Works with the Quality Assurance department to identify trends for training opportunities.Develops training program courses and schedules training sessions in collaboration with Claims ManagersSupervisors.Conducts training andor works with other subject matter experts to prepare and conduct trainings for both new staff and ongoing staff development.Creates effective written training materials and tools to support learningTrain staff on the adjudication process of all professional and outpatient facility claims including COB, denials, and reduction in service notificationsProcesses resolutions based upon contractual andor company agreements, involving the use of established payment methodologies, Division of Financial Responsibility, applicable regulatory legislation, claim processing guidelines and company policies and proceduresWrites andor provides input on operation desk procedures.Monitor progression of trainees through one-on-one observation and audit results.Provides feedback to Supervisors and Managers on staff performance relating to accuracy of work and ability to apply lessons.Participates in process improvement activities
HSGED. 3 years healthcare training experience preferably in examining and processing medical claims professional or institutional. ICD-10 and CPT coding and general practices of claims processing. MS Office.
MedicareMedi-Cal experience preferred.Prefer knowledge of capitated managed care environment.