CHRISTUS System Office
919 Hidden Ridge
Irving, TX 75038
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Under the supervision of the Claims Department Manager, the Claims Trainer develops, implements and facilitates inter and intradepartmental 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 establishing initiatives to standardize claims processing, improve claims auto adjudication and monitor claim inventory. This role will assist the Claims Manager with regulatory claim audits, escalated claims resolution 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 the workflow, creation of policies and procedures as reflected in the claims training manuals and scheduling and conducting department training.
- Communication and distribution of changes to department documents, identified issues, issue resolution and implementation of 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.
- Assesses claims 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 a 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)
- Analytic ability to organize and prioritize work to meet deadlines
- Ability to organize and prioritize work to meet deadlines
- Strong computer application skills including Microsoft Word, Excel and Visio
- Excellent written and verbal communication skills required
- Good judgment, initiative and problem solving abilities
- Ability to handle and resolve complex issues independently
- Knowledge of Medicaid, Medicare Advantage, Tricare and Health Care Exchange programs preferred
- Knowledge of claims processing, system configuration, edits, adjustment adjudication and claim department processes
- Knowledge of CPT/HCPCS, ICD-10 coding and medical terminology.
- Ability to learn new policies and processes based on written material and observation
- Ability to establish and maintain professional, positive and effective work relationships
- Bachelor's degree or 2 years of healthcare claims experience with managed care organization preferred
- Prior claim training experience preferred
- Two years claims processing experience with managed care preferred
- Extensive experience in healthcare or healthcare claims industry with understanding of provider data, reimbursement methodologies, benefit administration and claims adjudication processes.
- Ability to conduct effective and engaging presentations in a variety of delivery settings.
- Skilled in group facilitation and managing effective discussion and dialogue to enhance the learning experience.
- Prior experience working with TRICARE, Medicare Advantage and Health Exchange highly desirable.
- Knowledge of computer software and hardware to produce training materials, schedules, and documents. This includes but is not limited to Micro Soft Word, Excel and Power Point.
- Excellent organizational, interpersonal and communication skills required.
- Ability to teach adult learners effectively, and to lead and facilitate group processes.
- Knowledge of medical terminology and coding (CPT, ICD, HCPCS, Revenue Codes).
- Ability to work under stress and handle multiple tasks while maintaining a high level of quality.
- Adaptability and flexibility in a changing environment required.
- Demonstrate analytical and problem-solving abilities sufficient to effectively define complex problems and solutions in a logical and organized manner.
- Strong ability to manage multiple assignments simultaneously.
- Excellent proof reading, editing, oral and written communication skills.
- Excellent interpersonal and team/relationship building skills