Claims Trainer
PacificSource

Job Info

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Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: Create, update, and maintain Claims department policies, procedures, desktop instructions, and SharePoint sites for designated line of business (Commercial or Government). Provide support and coaching to internal staff regarding CMS rules regulations for Medicare claims processing. Provide support and coaching to internal staff regarding Oregon Health Authority and Oregon Administrative Rules for Medicaid claims processing. Work collaboratively with Claims department leadership to identify staff training needs. Perform claim audits and report to Claims Team Leads. Develop and maintain training materials that support the ability to process claims which meet or exceed accuracy and production standards. Assist in high-level claims processing or adjustment processing in times of critical need and/or when training duties are up-to-date.

Essential Responsibilities:

• Perform claim audits on work the cohorts have completed by researching appropriate benefits, reimbursement contracts, claim edits, system configuration, and government desktops, as well as policies and procedures related to designated line of business. Provide immediate feedback on claims with errors to claims analysts and team leaders.
• Engage and stay abreast with department leadership team to plan and/or deliver continued education to address updating policy and procedures when CMS/OHA rules and regulations are updated.
• Develop, update, and maintain department specific training materials, policies, and desktop procedures. Track aging status of existing documentation and ensure timely updates in order to keep the documentation current.
• Assist the leadership team in identifying areas where process improvement is needed. Actively participate in process improvement initiatives to ensure efficiency, accuracy, and effectiveness in the department.
• Document issues benefit, configuration, issues that affect claims processing/analyzing and advise appropriate internal personnel.
• Provide training to new hires and perform ongoing training within the designated Claims department.
• Extract claims from the designated claims inventory reports on a needed basis and for training purposes to provide claims for training purposes.
• Work collaboratively with Facets Business Support to identify issues that require remediation. Assist with testing, validation of configuration changes and monitor the results of new functionality to ensure efficiency and effectiveness.
• Provide claims analyzing for both lines of business Medicare/Medicaid and/or adjustment processing for both lines of business Medicare/Medicaid in customer service tasks, audit email queue, Onbase rebill queues, SharePoint Tasks, assistance when/if training and documentation duties are up-to-date.
• Provide support to department staff and internal customers to answer questions regarding claims processing rules and processes. Provide support to internal and external customers regarding overpayment transactions.
• Assist in claim grievance and appeal research and resolution
• Develop and maintain positive relationships with outside vendors that contract with PacificSource for claims related services. May communicate via phone, email, or business letter.
• Develop training materials and deliver one-on-one or group training to other claims analysts using Lean training techniques as assigned.

Supporting Responsibilities:

• Participate in team and department meetings, mentor training and team building activities. Represent Claims Department in inter-departmental workgroup meetings as assigned.
• Demonstrate ability to delegate or seek assistance when needed from other resources or subject matter experts within PacificSource.
• Meet department and company performance and attendance expectations.
• Perform other duties as assigned.

Work Experience: 3 years in healthcare industry required with preference given to experience in a Claims Analyst position.

Education, Certificates, Licenses: High school diploma or equivalent required. Previous instruction or experience in training others is preferred.

Knowledge: Requires experience in Facets Medicare/Medicaid and Coordination of Benefits claims analyzing. Skilled in training techniques that address a variety of learning styles and personalities. Ability to understand and interpret PacificSource contract provisions applicable to the expanded service area. Advanced skills in Microsoft PowerPoint, Excel, Word, and Outlook. Intermediate level or above experience with ICD-10, CPT, coding, HCPCS, medical terminology, CMS rules and regulations, and medical billing best practices are required. Requires strong written documentation skills necessary to produce clear and concise department documentation and training materials. Must have the ability to develop and deliver appropriate training based presentations to department staff.

Competencies

• Building Customer Loyalty
• Building Strategic Work Relationships
• Contributing to Team Success
• Planning and Organizing
• Continuous Improvement
• Adaptability
• Building Trust
• Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

This job has expired.