Job Details

Description

1. Conducts pre-payment, post-payment, and procedural audits. Assesses training needs based on audit results. Conducts group or one-on-one training. Performs post-training audits to ensure training effectiveness. Makes recommendations regarding training needs to supervisors or managers. Provides refresher training as needed or indicated by post-training audits and management recommendations.
2. Identifies and resolves processing issues that may involve, but are not limited to, the following activities:
   
   • Providing written or verbal responses to originating departments, including short memos, phone calls, and emails.
   • Departments can include but are not limited to: Customer Service, Statistics, Provider Services, Legal, ICMS, OMD, Utilization Management, and Benefits Integrity.
   • Providing staff training.
   • Proposing and documenting workflow changes, resolving suspend errors (pricing instructions), and provider education.
   • Collaborating with OMD and/or Provider Services regarding changes and their impact on providers.
   • Updating eligible charge loads and making system improvements or corrections, working with BCIS and/or IS as needed.
3. Provides coaching and mentoring to staff at all levels. Acts as a resource to staff and internal customers (including but not limited to OMD, Provider Services, Benefits Integrity, Customer Service, CR-Legal) and some external customers (such as auditors, providers, members) for all QNXT transactions and databases related to production, including manual transactions, adjustments, and overrides.
4. Assists the supervisor in daily unit operations, including but not limited to:
   
   • Assigning work to staff based on their knowledge, workload, performance expectations, and coverage needs during sick leave and vacation.
   • Processing exception, individual consideration, or complex and high-level claims.
5. Attends and successfully completes HMSA training classes as assigned.
6. Performs other miscellaneous responsibilities and duties as assigned or directed.

#LI-Hybrid

Qualifications

• Associate's degree and one year of experience in the healthcare industry or an equivalent combination of education and work experience.
• Experience in conducting one-on-one or group training sessions.
• Excellent verbal and written communication skills.
• Basic working knowledge of Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint.