Hours of Work :
40Days Of Week :
Monday - FridayWork Shift :
Job Description :
You will develop, implement, and facilitate a claims training program with an emphasis on appeals and denials. A candidate with in-depth knowledge in the insurance industry and a proven ability to train employees in a fast paced environment. This role is key to securing reimbursement and minimizing organizational write-offs.
Key Responsibilities:
Subject matter expert with a complete understanding of professional billing. Maintains working knowledge of all departmental workflows and processes, applicable insurance carriers’ timely filing deadlines, claims submission and resubmission processes, and appeal processes.
Lead the development, implementation, and continuous improvement of claims training curriculum and education initiatives. Collaborate with managers and team leads to identify workflow gaps, develop AR follow-up policies and procedures, and ensure they are accurately reflected in training manuals. Schedule and conduct comprehensive department training sessions.
Create and continuously update training resources and documentation. Collaborate with team leads, claims staff, and cross-departmental team members to enhance the quality and relevance of training materials.
Provide denial and payer related issue trends to leadership for escalation of data to payer relations team. Support department leadership through research, analysis, and special project assistance. Actively participate in huddle meetings and share detailed case insights.
Team coaching and standards compliance providing ongoing coaching and refresher training to ensure team adherence to standards, regulations, and best practices.
Train new employees and teach strategies for prioritizing cases, reviewing account history, remit, and payer history to determine the appropriate challenge and appeal strategy.
Understanding knowledge of medical terminology, CPT codes, modifiers, and diagnosis codes.
Complete understanding of the revenue cycle process to include prior authorization, billing, insurance appeals, and physician billing collection.
Apply prior knowledge of denials to assess and ensure services/items billed are reasonable and necessary.
Promote collaborative teamwork and proactively suggest procedural improvements to management to enhance departmental efficiency and effectiveness.
Communicate clearly and openly
Be accountable for your performance
Take initiative for your professional growth
Be engaged and eager to build a winning team
Job Requirements:
An Associate Degree in Accounting, Finance or Business Administration or equivalent experience in the Healthcare Industry.
Professional Certification through AAHAM, HFMA, or EPIC preferred
Methodist Health System is a faith-based organization with a mission to improve and save lives through compassionate, quality healthcare. For nearly a century, Dallas-based Methodist Health System has been a trusted choice for health and wellness. Named one of the fastest-growing health systems in America by Modern Healthcare, Methodist has a network of 12 hospitals (through ownership and affiliation) with nationally recognized medical services, such as a Level I Trauma Center, multi-organ transplantation, Level III Neonatal Intensive Care, neurosurgery, robotic surgical programs, oncology, gastroenterology, and orthopedics, among others. Methodist has more than two dozen clinics located throughout the region, renowned teaching programs, innovative research, and a strong commitment to the community. Our reputation as an award-winning employer shows in the distinctions we’ve earned: