Designs & conducts new adjudicator & focused training programs relating to claims administration & processing teams. room functions, Research & Resolution Team & Claims Accounting, & Collection & Refunds, ensuring all training materials & classes support KP's Culture of Compliance, Ethics & Integrity. Maintains a current & up to date reference base, (known as Desk Level Procedure's), of all pertinent policies & procedures to ensure the Claims personnel are trained to perform their duties in accordance w/ applicable regulatory requirements, external laws & accreditation standards as they relate to Claims Administration in the Claims Administration Department. Develops trending analysis reports to identify training deficiencies & include proposed enhancements to the training criteria to eliminate deficiencies. Maintains knowledge of policies & procedures & performs in accordance w/ applicable regulatory requirements, external laws & accreditation standards as they relate to Claims Administration.
Essential Functions:
- Analyzes the training needs of the Claims Administration Department based on audit results, monthly reports, provider appeals & provider meetings notes & action items
- Analyses specific gaps or weaknesses in Claims administration process where additional training would be beneficial, developing & conducting training programs to address those needs
- Maintains a current & up to date training base of information in the DLP's & any other source used for instruction, making modifications as necessary to be used as a resource after training has been completed
- Prepares training areas & establishes system environments for training programs to include system access, system region, the specifics needed for each class including PC w/ appropriate programs loaded, practical examples of system applications & queues to access claims, before the start of any class
- Prepares & distributes to the managers, supervisor & trainee a specific syllabus to be used for each new or focus training class
- Prepares & forwards signoff sheets that show each item that was covered in the training class which includes a spot for trainer, trainee & supervisor of the person being trained regardless of the content or size of class
Qualifications:
Basic Qualifications:
- 3 years experience in planning and conducting medical claims processing training classes required.
- Bachelor's degree or equivalent experience In the field of Training & Development, Claim administration, Education, Communications or related field
- Demonstrated experience in advance computer applications e.g. Microsoft Word, Excel, and Power Point, pivot tables with a preference for working knowledge and proficiency in reporting software such as Business Objects or Crystal
- Strong written and verbal communication skills with emphasis on teaching and communicating effectively with a group
- Demonstrated ability to interact with all staff levels
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.