PacificSource Health Plans

  • Claims Training Coordinator & Business Analyst

    Job Location US-OR-Eugene
    Job ID
    2018-430
    Type
    Regular Full-Time
    Hiring Pay Range
    $17.50-$20.00 an hour
    # of Openings
    1
    Status
    Non-Exempt
  • Overview

    Work collaboratively with department leadership to identify staff training needs. Plan and/or deliver continued education to department staff. Develop and maintain training materials that support the ability to process claims which meet or exceed accuracy and production standards. Create, update and maintain all department policies, procedures, and desktop instructions. Analyze data and produce accurate and timely productivity, quality and statistical reports for the department manager. Work with Facets Business Support staff to identify and resolve workflow and claims processing issues in Facets. Assist in high-level claims processing or adjustment processing in times of critical need and/or when training duties are up-to-date.

    Responsibilities

    1. Engage with department leadership team to plan and/or deliver continued education to address new claims processing situations or areas identified as ‘needs improvement’. Arrange for guest presenters to present training sessions if subject matter experts are needed.
    2. Develop, update, and maintain department specific training materials, policies, desktop procedures and job breakdown sheets. Track aging status of existing documentation and ensure timely updates in order to keep the documentation current.
    3. Assist the leadership team in identifying areas where process improvement is needed. Actively participate in process improvement initiatives to ensure efficiency, accuracy, and effectiveness in the department.
    4. Document issues that affect claims processing and advise appropriate internal personnel of processing concerns and/or problems. Use established communications channels to notify internal departments and personnel.
    5. Analyze data and produce accurate and timely productivity, quality and statistical reports as assigned by department manager.
    6. Request reports and/or create queries on an as needed basis to assist with identifying and resolving discrepancies.
    7. Work collaboratively with Facets Business Support to identify core system issues that require remediation. Assist with testing, validation of configuration changes and monitor the results of new functionality to ensure efficiency and effectiveness.      
    8. Provide claims processing and/or adjustment processing assistance when/if training and documentation duties are up-to-date.

     

    Supporting Responsibilities:

    1. Participate in team and department meetings, mentor training and team building activities. Represent Claims Department in inter-departmental workgroup meetings as assigned.
    2. Demonstrate ability to delegate or seek assistance when needed from other resources or subject matter experts within PacificSource.
    3. Meet department and company performance and attendance expectations.
    4. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    5. Perform other duties as assigned.

    Qualifications

    Work Experience: Minimum of three years’ health insurance or related experience required. Requires strong written documentation skills necessary to produce clear and concise department documentation and training materials. Must have the ability to develop and deliver appropriate training based presentations to department staff. Claims processing skills equal to or exceeding that of a Claims Analyst III are desired.

     

    Education, Certificates, Licenses: High school diploma or equivalent required. Previous instruction or experience training others is preferred.

     

    Knowledge: Requires experience with, and detailed knowledge and understanding of Facets claims processing and department workflow. Ability to use training techniques that address a variety of learning styles and personalities. Ability to understand and interpret PacificSource contract provisions applicable to the expanded service area. Average to advanced skills in Microsoft PowerPoint, Excel, Word, Visio and Outlook.  Intermediate level or above experience with ICD-10 and CPT coding, and medical terminology are required. Knowledge of government programs claims processing is helpful.

     

    Competencies

    Our Values

    •   Building Customer Loyalty
    •   Building Strategic Work Relationships
    •   Continuous Improvement
    •   Adaptability
    •   Building Trust
    •   Work Standards
    •   Contributing to Team Success  
    •   Planning and Organizing

     

     

    • We are committed to doing the right thing.
    • We are one team working toward a        common goal.  
    • We are each responsible for our customers’ experience.
    • We practice open communication at all        levels of the company to foster individual, team and company growth.  
    • We actively participate in efforts to improve our many communities-internal and external.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

     

     

     

    Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

     

    Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

     

    Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

     

    PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

     

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