Claims Operational Coordinator Job at Driscoll Health
Where compassion meets innovation and technology and our employees are family.
Thank you for your interest in joining our team! Please review the job information below.
General Purpose of Job:
The Claims Operational Coordinator will be responsible for the development and delivery of operational, technical, and procedural workflow training for the Claims Administration team. The Claims Operational Coordinator provides an important function in assisting the department to meet or exceed all quality benchmarks, and to maintain adherence with Texas Medicaid requirements for claims functions.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. This job description is not intended to be all-inclusive; the role will perform other reasonably related business duties, assigned by the immediate supervisor or department director, as required.
General Duties:
The above statements should be included on all job descriptions.
List the job's essential or most important functions and responsibilities. Include all important aspects of the job - whether performed daily, weekly, monthly, or annually; and any that occur at irregular intervals. Standard functions listed below should be included on all job descriptions.
- Maintains the utmost level of confidentiality at all times.
- Adheres to Health System and Health Plan policies and procedures.
- Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
- Performs other duties, as assigned
Claims Operational Coordinator Responsibilities:
- Develops, implements, and delivers all departmental training curriculum to ensure consistency, efficiency, and quality outcomes in claims department functions; including but not limited to claim support, claims processing, claims adjustments, refund processing, claim appeals, provider claim resolution, and provider claim analysis.
- Delivers training to new hires, as well as experienced staff.
- Collaborates with departmental leadership and SMEs in training initiatives related to process improvement.
- Remains current in understanding and knowledge of all department workflows and processes.
- Delivers training in the most appropriate format, including virtually, in a classroom setting, and directly with individuals
- Develops training outlines, timelines, materials, and knowledge tests for all department training initiatives
- Evaluates trainee performance, and provides appropriate feedback to departmental leadership
- Maintains positive, consistent communication with Claims staff.
- Maintains accurate training records.
- Utilizes appropriate training and motivational techniques to help staff achieve peak performance.
- Maintains a positive attitude, composure, and flexibility under pressure.
Education and/or Experience:
- Associates degree preferred.
- 1-2 years of training experience, preferably in a claims processing environment.
- Experience in adult education preferred.
- Analytical and reporting experience
- Broad knowledge of health plan operations, specific knowledge of claims, and key educational processes.
- Experience utilizing claims processing systems, EPIC Tapestry preferred.
- Demonstrated proficiency in MS Office applications, particularly Word, PowerPoint and Excel.
- Ability to multi-task.
- Ability to effectively interact with employees at all levels of the organization.
- Ability and willingness to work flexible hours to support the claims department training needs.
- Outstanding problem-solving and organizational skills.
- Ability to assess departmental training needs and recommend actions.
- A wide degree of creativity and latitude.
- Excellent listening skills.
- Ability to communicate effectively both orally and in writing.
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