Claims Trainer
Company: Christus Health
Location: Irving
Posted on: May 14, 2022
Job Description:
DescriptionSummary:Under the supervision of the Claims
Department Manager, this position is responsible for balancing
workloads, assisting with establishment of structure and
standardization, creation and updating of departmental policies and
process and implementation and maintenance of oversight within the
Claims Department. Monitoring of claim processing production and
quality are required. Improvement initiatives in increasing claims
auto adjudication will be performed. Additional functions of this
role are supervising overall claim inventory, resolving escalated
claim issues and assisting Claims Examiners with policy, regulatory
or contractual questions and concerns. This position also will
assist in audit related decision making and in training new Claims
Examiners on job-specific roles and responsibilities.
- Assists in training new Claims Examiners on job specific roles
and responsibilities
- Meet and/ or exceed claims processing production
requirements
- Maintain statistical accuracy of 97%, and financial accuracy of
98%
- Correct DoD error report as needed
- Provide excellent customer service to internal and external
customers
- 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) - Requirements:
- 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
- 2 years Healthcare experience with Managed Care experience
required
- Prior Claim Team Management experience preferred
- Three years claims processing experience required with Managed
Care experience preferred
- Claim system configuration experience preferred
- Prior experience working with TRICARE, Texas Medicaid, Medicare
Advantage highly desirable.Work Type: - Full Time
Keywords: Christus Health, Irving , Claims Trainer, Human Resources , Irving, Texas
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