Trainer - Provider Enrollment

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 US health insurance payers 

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

Other duties as assigned 

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

At least 1 year Provider Enrollment production experience. 

Annual performance review rating of 3.0 (Meets Expectations) and last three (3) consecutive months scorecard of at least 3.5 (Meets Expectations) with all KPIs passing

Twelve (12) months tenure in Med-Metrix and current role

No Level 3 and above sanction for one (1) year prior to application

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. 

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

Assertive self-starter who can work independently, yet function in a team environment

Good interpersonal and other training soft skills

An understanding and strict adherence to all HIPAA regulations

Proficiency in Microsoft Office Suite 

Strong interpersonal skills, ability to communicate well at all levels of the organization 

Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses 

High level of integrity and dependability with a strong sense of urgency and results oriented  

Excellent written and verbal communication skills required