Job Purpose The Senior 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 2 years • 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 • Work Set-Up: Onsite • Work Schedule: US hours, night shift; must be flexible to accommodate business needs • 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.