Claims Educator

 
Position: Claims Educator

Job ID: 164501

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

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.    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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