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Training Specialist - Claims

Company: ProMedica Senior Care
Location: Toledo
Posted on: January 27, 2023

Job Description:

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA - the National Committee for Quality Assurance - for our Ohio HMO, Elite and Advantage products. We're also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com. Position SummaryThe Training Specialist is responsible for development and implementation of training programs for Provider Experience staff. Support corporate objectives by working with management to provide an effective education program that will advance the quality and production level of the interdepartmental staff. Develop comprehensive documentation for all types of customer service including incoming call centers, credentialing, provider database management, provider relations and claims processing, for all lines of business including specialty and governmental. Department liaison for all systems upgrades. ACCOUNTABILITIES

  • Responsible to provide training for new and/or current Provide Experience Department staff..Provide quality assurance for trainees through their training period.Assist with the orientation and integration of new to Paramount employees into the Provider Experience departments.Work directly with department staff and leadership to review issues and develop a corrective action plans, as needed, based on QA results.During training period, compile and analyze production data reports based on key performance indicators, and provide summary to team leaders, as well as recommendations for improvement in deficient areas.Participate extensively in the implementation of new software/programs that affect the rProvider Experience Departments, to support testing and recommendation of such applications.Perform other duties as directed to support Provider Experience.Actively participates in shared accountability and commitment for departmental and organization-wide results. Support departmental/team goals and objectives.
  • Education: Associates degree or equivalent experience in education, teaching, training, or claims processing proceduresSkills: Ability to handle difficult situations, desire to help others grow and develop.Years of Experience: 1-3 yearsPreferred Qualifications
    • Education:. Bachelor's Degree in Education, Marketing, healthcare or equivalent experience with training.Skills: Presentation skills, facilitation skills, Understand the Adult Learning Principles. Detailed knowledge of all aspects of medical and facility claims processing. Functional knowledge of adult learning theory, assessment, and evaluation is a plus.Years of Experience: Three to five years of processing all types of claims and/or customer service. Minimum of three years' experience in health insurance industry. Experience with multiple online software systems.License: TeachingCertification: Teaching ADDITIONAL EXPERIENCEAbility to interpret data, explain process of the "what, how, and why" of a claim.Documented knowledge with Word, Excel, and Access required. Demonstrated excellent written and oral communication skills.Must have excellent interpersonal skills, and must present a professional image for interaction with a variety of contacts.Must be adaptable to change and must be detail-oriented.Have ability to take initiative, work independently, and make sound judgment decisions.Demonstrated ability to handle details and maintain confidential information.Must be able to prioritize and handle large volumes of work.Must have ability to work in a production environment that can be stressful.Must maintain a high level of motivation, initiative, and accountability.Must be able to handle conflict in a positive, productive manner.Have ability to work in an open concept office environment. ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedicaQualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.orgEqual Opportunity Employer/Drug-Free Workplace

Keywords: ProMedica Senior Care, Toledo , Training Specialist - Claims, Other , Toledo, Ohio

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