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Claims Training Specialist
2 months ago
We are seeking a highly skilled Claims Training Specialist to join our team at Partnership HealthPlan of California. As a Claims Training Specialist, you will be responsible for training examiner and customer service level I staff on all related claim types for all PHC lines of business using AMISYS Advance system and Claims Operating Instruction Memorandums.
Key Responsibilities- Train all levels of staff on all claim types on-site or regional site(s).
- Train all levels of staff on CIF processing, generating and processing adjustments both on-site and regional site(s).
- Provide feedback and recommendation to the Claims Audit Supervisor and Associate Director of Claims on staff training needs and system adjustments.
- Create and maintain training materials.
- Maintain current knowledge of PHC Claims Policy and Procedures for all lines of business, Medi-Cal Provider Manual, Title 22 regulations, Knox Keene regulations, and CMS Medicare regulations.
- Draft Claims Operating Instruction documentation for the Claims Director as assigned.
- Assist with system testing as needed.
- Other duties as assigned.
- Education and Experience: Minimum two (2) years of claims examining experience and completion of PHC Claims training; or equivalent combination of education and experience.
- Special Skills, Licenses and Certifications: Familiar with Medi-Cal and/or managed care claims processing. Knowledge of CPT, HCPC procedure coding, and ICD-9/ICD10 diagnostic coding. Typing speed 30 wpm and proficient use of 10-key calculator. Familiar with AMISYS or similar claims systems. Understanding of claims examining requirements.
- Valid California driver's license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.
- Excellent oral and written communication skills.
- Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy.
- Ability to work on multiple tasks within established time frames and sometimes conflicting priorities.
- Good organizational skills with ability to maintain accurate records and documentation of actions and decisions.
- Ability to use a computer keyboard.
- More than 60% of work time is spent in front of a computer monitor.
- When required, ability to move, carry or lift objects of varying size, weighing up to 5 lbs.
- Provide the highest possible level of service to clients.
- Promote teamwork and cooperative effort among employees.
- Maintain safe practices.
- Abide by the HealthPlan's policies and procedures, as they may from time to time be updated.
