The posting
Job Purpose The Trainer is responsible for conducting medical billing, claim denials & appeals, revenue cycle management training programs for new and existing forensic billers. Performs actual medical billing & claim denials work for existing accounts on a regular basis to keep an up-to-date knowledge of the process. Participates in process implementation during account take offs or go-live. Duties and Responsibilities
Develops curriculum, training syllabus, and course modules related to Medical Billing (US Health Insurance, Claims Process, Denials & Appeals, Revenue Cycle Management) Develop basic account navigation workflow of billing system for both HP and PB (Epic, Athena) and other system tools (Encoder Pro, CCI Edit) used by the department Develops denials process workflow for common denials (Duplicate, Timely Filing, No Prior- Auth, Medical Necessity, etc.) Develops a guideline for common payer policies for US health insurance payers Update and improve existing training and process modules Coordinate with forensic quality department to identify areas for process improvement and produce materials for claim edits, denials workflow, systems & process training from client Develops and produces materials for Medical Billing, Denials, systems and process exercises and qualifying examinations Updates weekly deck (performance and attendance for training meeting) Participates in weekly training meetings with the upper management Collaborates with billing operations managers, supervisors, and quality to resolve issues that impact internal and external customers Develops and conducts Call/Phone Handling Training for the new hires and existing forensic billers Other duties as assigned Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Understand and comply with Information Security and HIPAA policies and procedures at all times Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Qualifications
At least 1 year Provider Enrollment production experience. Annual performance review rating of 3.0 (Meets Expectations) and last three (3) consecutive months scorecard of at least 3.5 (Meets Expectations) with all KPIs passing Twelve (12) months tenure in Med-Metrix and current role No Level 3 and above sanction for one (1) year prior to application Previous training work experience of at least a year Minimum of 2 years of medical billing or revenue cycle management experience specific to AR and Denials Management or provider side of the healthcare insurance industry In-depth understanding of claim denials CPB and Coding Certification (CPC, CCS, COC) is an advantage Supervisory experience preferred; demonstrated leadership skills Willingness and flexibility to work extended hours Knowledge of general computer applications and ability to multitask on two monitors. Ability to work in a team fostered environment and have the willingness to adjust to changing job responsibilities, shifting schedules, new procedures and unexpected workloads and stresses Assertive self-starter who can work independently, yet function in a team environment Good interpersonal and other training soft skills An understanding and strict adherence to all HIPAA regulations Proficiency in Microsoft Office Suite Strong interpersonal skills, ability to communicate well at all levels of the organization Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses High level of integrity and dependability with a strong sense of urgency and results oriented Excellent written and verbal communication skills required
