Claims Training Specialist III (ALD)

Job Summary

The Claims Training Specialist III is primarily responsible for the overall training strategy across the department and designing and conducting training programs using established departmental guidelines. This position is responsible for providing ongoing training on the core processing system, claims processing procedures, communicating regulatory changes which will affect established procedures, establishing quality and performance guidelines, creating and maintaining departmental policy and procedures. Additional responsibilities include evaluating initial training and ongoing learning opportunities to achieve consistency, efficiency, and productivity among the staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

Duties

As a Subject Matter Expert, applies knowledge and skills to build competencies for the design of training programs that will boost employee’s workplace performance in alliance with Enterprise and departmental goals. Responsible for performing training needs assessments with the department management and will leads the design and delivery of  curriculum and learning materials to ensure the success of new and current staff.

Work with document specialists to create training presentations and with Human Resource to customize training for inclusion into the L.A Care University.

Maintain documentation, including database/system updates, training agendas, sign-in sheets, etc. to demonstrate trainee compliance with department requirements.

Work with key stakeholders to monitor error trends, productivity, and quality standards for the program. Identifies gaps in knowledge, skills and abilities, assess and recommend training/education measures to resolve issues and enhance staff performance.

Research provider and member grievances to identify error trends and training opportunities. Create and develop tracking and trending mechanisms to identify type of grievances/ complaints.  Propose program modifications to enhance performance and positively influence member satisfaction survey results.

Conduct assessments after training  to measure, record, and report feedback on training material and sessions. Serve as coach staff to handle problems and concerns as they arise.

Review and recommends updates on policy and procedure critical to claims process.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

A minimum of 3 years of Managed Care experience.

A minimum of 3 years of Medi-Cal and Medicare claims processing or auditing experience.

A minimum of 3 years of experience in design and delivery (facilitating and coordinating) of training programs.

Preferred: 

Policy writing experience.

Skills

Required:

Strong understanding of learning principles and ability to demonstrate in classroom (or virtual classroom) situations.

Knowledge of ICD-9 and CPT coding and general practices of claims processing.

Skilled in group facilitation and managing effective discussion and dialogue to enhance the learning experience.

Strong organizational skills.

Ability to conduct effective and engaging presentations in a variety of delivery settings.

Professional demeanor. Commitment to Team Culture.

Excellent written and verbal communications skills

Proficient using Word, Excel, and Access. 

Knowledge of CA regulatory guidelines, Medi-Cal rules, CPT/ICD-10 coding, CMC LOB.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information