Banner Health Health Plan Claims Educator in Tucson, Arizona
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This position is responsible for the training needs of Health Plan staff, including development of training materials, communications and activities. Provides training in all aspects of Case Management, medical management, compliance, and Claims adjudication to include professional, facility and dental claims. Responsible for regulatory guidance with AHCCCS, Commercial and Medicare rules and regulations Develops individualized and group training programs for staff based on regulations and contractual requirements, business needs, audit findings and claims adjustment team database
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
This position is responsible for the training needs of Health Plan staff, including development of training materials, communications and activities. Provides training in all aspects of Case Management, medical management, compliance, and Claims adjudication to include professional, facility and dental claims. Responsible for regulatory guidance with AHCCCS, Commercial and Medicare rules and regulations Develops individualized and group training programs for staff based on regulations and contractual requirements, business needs, audit findings and claims adjustment team database errors.
Leads and manages training and provides educational guidance in Claims, Medical Management and Case Management staff as well as other areas of the organization. Develops, plans and implements individual and group training programs and materials based on business needs.
Interfaces with all departments within the health plan to ensure that the Claims, Medical Management training program supports all Customer Care, Medical Management, Network development, Grievance & Appeals, Case Management, Disease Management, Utilization Management and other care management programs.
Maintains working knowledge of AHCCCS and/or ALTCS and Medicare rules and regulations, HCPC/CPT, ICD-9, ICD-10 codes and other various guidelines as they impact the health plan, claims adjudication, regulatory compliance or medical management. For Claims, working knowledge of adjudication processing to ensure current processes and systems match training material content.
Assists managerial staff in developing and maintaining specific work procedures, policies and procedures, and process improvement processes. Provides timely and consistent feedback to managerial and supervisory staff in reference to training staff as well as works with supervisory staff on the progress of trainee’s goals during the training period. Acts as a resource for staff.
Analyzes and utilizes data to provide focused individualized and/or group training for areas identified as needing additional training. Analyzes data and prepares weekly training schedules/reports for training.
Develops “train the trainer” program and keeps the “trainers” supplied with updated training materials. Assists in the designing and developing of web-based training materials. Manages and monitors priorities of active learning requests.
Participates in all mandatory compliance and other training programs and seeks guidance for compliance-related concerns and adheres to all applicable laws, regulations and HP policies and procedures.
Works independently under general supervision and exercises independent judgment. Flexes training programs based on training needs of department. Communicates with and build strong relationships with all staff and departments. Presents in a variety of formal presentation settings: one-on-one, small and large groups, with peers, and bosses; is effective both inside and outside of the organization, on both cool data and hot and controversial topics; commands attention and can manage group process during the presentation and can change tactics midstream when something is not working. Establishes good working relationships with all levels of support staff, providers, administrative staff and all other internal and external customers.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.
High School or equivalent
Knowledge, skills and abilities as normally obtained through two years training experience in an insurance and/or healthcare environment and three years related experience with Case Management, Disease Management, Utilization Management or Professional, Dental and institution claims types. Strong working knowledge of Microsoft Office Software (Word, Excel, Visio and PowerPoint) and IDX. Good organizational and analytical skills, strong written and verbal communication skills. Ability to pay close attention to detail and proficiency in multiple learning disciplines. Knowledge of medical terminology and coding (ICD-9, CPT-4) and guidelines for JCAHO, NCQA, HEDIS, CMS, and AHCCCS may be required.
Bachelors in Healthcare or related field or equivalent. Experience with IDX, Avidity, Seibel, Acuity, Cerecons and Idx preferred; Experience with AHCCCS or ALTCS preferred.
Additional related education and/or experience preferred.
Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.