Trainer

Job Purpose

The Trainer is responsible for conducting medical billing, claim denials & appeals, revenue cycle management training programs for new and existing forensic billers. Performs actual medical billing & claim denials work for existing accounts on a regular basis to keep an up-to-date knowledge of the process. Participates in process implementation during account take offs or go-live.

Duties and Responsibilities

• Develops curriculum, training syllabus, and course modules related to Medical Billing (US Health Insurance, Claims Process, Denials & Appeals, Revenue Cycle Management)
• Develop Basic Account Navigation Workflow of Billing System for both HP and PB (Epic, Athena) and other system tools (Encoder Pro, CCI Edit) used by the department
• Develops Denials Process workflow for Common Denials (Duplicate, Timely Filing, No Prior- Auth, Medical Necessity, etc.)
• Develops a guideline for common Payer Policies for the Top US Health Insurance Payers (Aetna, BCBS, Humana, UHC, Cigna, etc.)
• Update and improve existing training and process modules
• Coordinate with forensic quality department to identify areas for process improvement and produce materials for claim edits, denials workflow, systems & process training from client
• Develops and produces materials for Medical Billing, Denials, Systems and Process exercises and qualifying examinations
• Updates weekly deck (performance and attendance for training meeting)
• Participates in weekly training meetings with the upper management
• Collaborates with billing operations managers, supervisors, and quality to resolve issues that impact internal and external customers
• Develops and conducts Call/Phone Handling Training for the new hires and existing forensic billers
• Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• Previous training work experience of at least a year
• Minimum of 2 years of medical billing or revenue cycle management experience specific to AR and Denials Management or provider side of the healthcare insurance industry
• In-depth understanding of claim denials
• CPB and Coding Certification (CPC, CCS, COC) is an advantage
• Supervisory experience preferred; demonstrated leadership skills
• Willingness and flexibility to work extended hours
• Knowledge of general computer applications and ability to multitask on two monitors. Proficient with Microsoft Office products
• Ability to work in a team fostered environment and have the willingness to adjust to changing job responsibilities, shifting schedules, new procedures and unexpected workloads and stresses
• Possess strong verbal, written communication, interpersonal and analytical skills
• Assertive self-starter who can work independently, yet function in a team environment
• Ability to plan well and prioritize work and maintain calmness under pressure
• Good interpersonal and other training soft skills
• An understanding and strict adherence to all HIPAA regulations

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.