L.A. Care Health Plan
Claims Training Specialist III (ALD)
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Claims Training Specialist III (ALD)
Job Category: Claims Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11803 Salary Range:
$77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members. Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents. The Claims Training Specialist III is primarily responsible for the overall training strategy across the department and designing and conducting training programs using established departmental guidelines. This position is responsible for providing ongoing training on the core processing system, claims processing procedures, communicating regulatory changes which will affect established procedures, establishing quality and performance guidelines, creating and maintaining departmental policy and procedures. Duties
As a Subject Matter Expert, applies knowledge and skills to build competencies for the design of training programs that will boost employee’s workplace performance in alignment with Enterprise and departmental goals. Responsible for performing training needs assessments with the department management and will lead the design and delivery of curriculum and learning materials to ensure the success of new and current staff. Work with document specialists to create training presentations and with Human Resources to customize training for inclusion into the L.A Care University. Maintain documentation, including database/system updates, training agendas, sign-in sheets, etc., to demonstrate trainee compliance with department requirements. Work with key stakeholders to monitor error trends, productivity, and quality standards for the program. Identifies gaps in knowledge, skills, and abilities, assess and recommend training/education measures to resolve issues and enhance staff performance. Research provider and member grievances to identify error trends and training opportunities. Create and develop tracking and trending mechanisms to identify types of grievances/complaints. Propose program modifications to enhance performance and positively influence member satisfaction survey results. Conduct assessments after training to measure, record, and report feedback on training material and sessions. Serve as coach to staff to handle problems and concerns as they arise. Review and recommend updates on policy and procedure critical to claims process. Perform other duties as assigned. Education Required
Bachelor's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred
Master's Degree in Business or Healthcare Related Field Experience
Required: A minimum of 3 years of Managed Care experience. A minimum of 3 years of Medi-Cal and Medicare claims processing or auditing experience. A minimum of 3 years of experience in design and delivery (facilitating and coordinating) of training programs. Preferred: Policy writing experience. Skills
Required: Strong understanding of learning principles and ability to demonstrate in classroom (or virtual classroom) situations. Knowledge of ICD-9 and CPT coding and general practices of claims processing. Skilled in group facilitation and managing effective discussion and dialogue to enhance the learning experience. Strong organizational skills. Ability to conduct effective and engaging presentations in a variety of delivery settings. Professional demeanor. Commitment to Team Culture. Excellent written and verbal communication skills. Proficient using Word, Excel, and Access. Knowledge of CA regulatory guidelines, Medi-Cal rules, CPT/ICD-10 coding, CMC LOB. Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light Additional Information
Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. This position is a limited duration position. The term of this position is a minimum of one year and a maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits. L.A. Care offers a wide range of benefits including: Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Nearest Major Market:
Los Angeles Job Segment:
Claims, Medicare, Insurance, Healthcare
#J-18808-Ljbffr
Job Category: Claims Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11803 Salary Range:
$77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members. Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents. The Claims Training Specialist III is primarily responsible for the overall training strategy across the department and designing and conducting training programs using established departmental guidelines. This position is responsible for providing ongoing training on the core processing system, claims processing procedures, communicating regulatory changes which will affect established procedures, establishing quality and performance guidelines, creating and maintaining departmental policy and procedures. Duties
As a Subject Matter Expert, applies knowledge and skills to build competencies for the design of training programs that will boost employee’s workplace performance in alignment with Enterprise and departmental goals. Responsible for performing training needs assessments with the department management and will lead the design and delivery of curriculum and learning materials to ensure the success of new and current staff. Work with document specialists to create training presentations and with Human Resources to customize training for inclusion into the L.A Care University. Maintain documentation, including database/system updates, training agendas, sign-in sheets, etc., to demonstrate trainee compliance with department requirements. Work with key stakeholders to monitor error trends, productivity, and quality standards for the program. Identifies gaps in knowledge, skills, and abilities, assess and recommend training/education measures to resolve issues and enhance staff performance. Research provider and member grievances to identify error trends and training opportunities. Create and develop tracking and trending mechanisms to identify types of grievances/complaints. Propose program modifications to enhance performance and positively influence member satisfaction survey results. Conduct assessments after training to measure, record, and report feedback on training material and sessions. Serve as coach to staff to handle problems and concerns as they arise. Review and recommend updates on policy and procedure critical to claims process. Perform other duties as assigned. Education Required
Bachelor's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred
Master's Degree in Business or Healthcare Related Field Experience
Required: A minimum of 3 years of Managed Care experience. A minimum of 3 years of Medi-Cal and Medicare claims processing or auditing experience. A minimum of 3 years of experience in design and delivery (facilitating and coordinating) of training programs. Preferred: Policy writing experience. Skills
Required: Strong understanding of learning principles and ability to demonstrate in classroom (or virtual classroom) situations. Knowledge of ICD-9 and CPT coding and general practices of claims processing. Skilled in group facilitation and managing effective discussion and dialogue to enhance the learning experience. Strong organizational skills. Ability to conduct effective and engaging presentations in a variety of delivery settings. Professional demeanor. Commitment to Team Culture. Excellent written and verbal communication skills. Proficient using Word, Excel, and Access. Knowledge of CA regulatory guidelines, Medi-Cal rules, CPT/ICD-10 coding, CMC LOB. Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light Additional Information
Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. This position is a limited duration position. The term of this position is a minimum of one year and a maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits. L.A. Care offers a wide range of benefits including: Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Nearest Major Market:
Los Angeles Job Segment:
Claims, Medicare, Insurance, Healthcare
#J-18808-Ljbffr