What are the responsibilities and job description for the Quality Assurance Trainer position at HMSA?
Conducts pre-payment, post-payment, and procedural audits. Assesses training needs based on audit results. Conducts group or one-on-one training. Performs post-training audits to ensure training effectiveness. Makes recommendations regarding training needs to supervisors or manager. Provides refresher training as needed or indicated by post-training audits and management recommendation.
Identifies and provides resolution to processing issues that may involve but are not limited to one or all of the following activities:
Written or verbal responses to originating departments that can include but are not limited to short memos, phone calls, email.
Departments can include but are not limited to the following: Customer Service, Statistics, Provider Services, Legal, ICMS, OMD, Utilization Management and Benefits Integrity.
Providing staff training.
Proposing and documenting workflow changes, suspend error resolutions (pricing instructions) and provider education.
Working with OMD and/or Provider Services regarding changes and impact to providers.
Updates to eligible charge load and improvements/corrections to the system including working with BCIS and/or IS as needed.
Provides coaching and/or mentoring to staff at all levels. Acts as a resource to staff and internal customers (including but not limited to OMD, Provider Services, Benefits Integrity, Customer Service, CR-Legal) and some external customers (i.e., auditors, providers, members) for all QNXT transactions and databases related to production including but not limited to manual transactions, adjustments, and overrides.
Assists supervisor in daily unit operations including but not limited to:
Assigning work to staff based on staff knowledge, unit workload, performance expectations and coverage for sick leave and vacation.
Processing exception, individual consideration, or complex and high-level claims.
Attend and successfully complete HMSA training classes as assigned.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
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