Medical Claims Educator - The Health Plan

 
Position: Medical Claims Educator - The Health Plan

Job ID: 160197

Location: US-TX-Houston

Department: CLAIMS AUDITOR

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

Texas Children’s Health Plan   The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health.    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.   We are an Integrated Community System providing holistic care that empowers families to live healthier lives.     Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.  Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals.    To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org   

Summary:

We are searching for a Medical Claims Educator -- someone who works well in a fast-paced setting. In this position, you will lead in the design, development, and implementation of training programs for new and existing employees. This role will enhance the competency, performance, and professional development of the Claims Administration team. This position is critical in the development and ongoing accuracy of claims processing to ensure accurate reimbursement to providers.

 

Think you’ve got what it takes?



Responsibilities :

  • Designs and develops training manual and desktop procedures to encompass the major areas of Claims Administration including data entry, mailroom and claims examination
  • Conducts training program to provide an effective and interactive learning environment to achieve departmental goals and objectives utilizing innovative, professional communication methods
  • Assures that staff completes Health Plan and departmental orientation upon employment as monitored by training records
  • Develops and completes measurable job-specific training as identified by statistical reports and audits
  • Completes audits, consistent with industry standards, of each claim examiner/specialist trainee’s completed throughout the course training and within the nesting period
  • Performs specific training on Information Systems used in Claims Administration
  • Recommends application and program enhancements to improve workflow processes
  • Coordinates and facilitates all aspects of end-user testing for system updates/conversions


Qualifications:

  • Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption
  • High school diploma or GED required
  • 4 years previous training experience in an adult training environment required
  • A bachelor’s degree may substitute for two years of the required experience


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