Claims Educator

 
Position: Claims Educator

Job ID: 164034

Location: US-Remote TX Based

Department: CLAIMS AUDITOR

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a -5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for the women and children that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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, to enhance the competency, performance, and professional development of the Health Plan Medical 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 :

  • Develops and coordinates the Medical Claims Administration Training Program
  • 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. Documents competency scores for Pre & Post Assessments to ensure comprehension of the material presented to employees
  • Provides staff with ongoing job-specific training programs, in services, and continuing education opportunities
  • Develops and completes measurable job-specific training as identified by statistical reports and audits
  • Collects and evaluates feedback on training program initiatives and makes recommendations for improvement
  • Completes audits, consistent with industry standards, of each claim examiner/specialist trainees completed throughout the course training and within the nesting period
  • Completes audits of post-ad-hoc or refresher training claim processing
  • Supports the development and action plan follow-up for individuals as required
  • Provides Information System Application Expertise
  • 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, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption
  • S. Diploma or GED
  • 4 years of previous training experience in an adult training environment
  • A Bachelor's degree may substitute for two (2) years of the required experience


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