Partnership HealthPlan of California · 1 month ago
Claims Trainer
US-CA-Fairfield
Full-time
Onsite
Entry Level
$32.51/hr - $39.01/hr
2+ years expPartnership HealthPlan of California is seeking a Claims Trainer to educate examiner and customer service staff on various claim types. The role involves training, maintaining training materials, and providing feedback on staff training needs.
Health CareInsuranceNon Profit
Responsibilities
Train examiner and customer service level I staff on all related claim types for all Partnership lines of business using AMISYS Advance system and Claims Operating Instruction Memorandums
Train all levels of staff on all claim types on-site or regional site(s)
Train all levels of staff on CIF processing, generating and processing adjustments both on-site and regional site(s)
Provide feedback and recommendation to the Claims Audit Supervisor and Associate Director of Claims on staff training needs and system adjustments
Create and maintain training materials
Maintain current knowledge of Partnerhsip Claims Policy and Procedures for all lines of business, Medi-Cal Provider Manual, Title 22 regulations, Knox Keene regulations, and CMS Medicare regulations
Draft Claims Operating Instruction documentation for the Claims Director as assigned
Assist with system testing as needed
Other duties as assigned
Qualification
Required
Minimum two (2) years of claims examining experience and completion of Partnership Claims training; or equivalent combination of education the experience
Familiar with Medi-Cal and/or managed care claims processing
Knowledge of CPT, HCPC procedure coding, and ICD -9/ICD10 diagnostic coding
Typing speed 30 wpm and proficient use of 10-key calculator
Familiar with AMISYS or similar claims systems
Understanding of claims examining requirements
Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business
Excellent oral and written communication skills
Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy
Ability to work on multiple tasks within established time frames and sometimes conflicting priorities
Good organizational skills with ability to maintain accurate records and documentation of actions and decisions
Ability to use a computer keyboard
More than 60% of work time is spent in front of a computer monitor
When required, ability to move, carry or lift objects of varying size, weighing up to 5 lbs
Company
Partnership HealthPlan of California
Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
L
Lorna Veloso
Sr. Manager of OpEx/PMO
Recent News
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