Lead Trainer, Claims and Provider Disputes

As the Lead Trainer Claims and Disputes you will play a key role in Guidehealths expansion and growth. You will provide operational and technical support to both the claims production and provider dispute teams. This position is considered a subject matter expert and will be responsible for the training of new staff and existing staff on updated procedures. This role will report to the Manager Administrative Support.

WHAT YOULL BE DOING

• Coordinate training alongside the respective managers of each claims team Claims Operations and Provider Disputes.
• Provide technical system support to the claims production analysts and provider dispute analysts and assist with the teams inquiries enter JIRA tickets and coordinate data with technical teams to complete the tickets.
• Responsible for coaching and mentoring on training progress.
• Update operating procedures as necessary and communicate to both teams and new updates.
• Assist the managers with the weekly review of Pre-Audit reports.
• Assist with the monitoring of workflows and backlogs by running access queries and Power BI reporting that relate to Disputes OPX/MOOP reconciliations interest payment requirements Misdirected Claim Review.
• Assist in processing when needed.
• Help answer BCBS inquiries relating to DOI Complaints Grievances and general status inquiries.
• Coordinate and report all required health plan web-based reporting.
• The managers will review audit stats with you regarding the individual staff for the improvement and continued need of coaching and processing corrections.
• Attending meetings as assigned.
• Assist in coverage of the analysts and manager during FTO Medical Leaves etc.
• Other duties and responsibilities as assigned.

Qualifications :

WHAT YOULL NEED TO HAVE

• Minimum 3 years claims processing experience with Eldorado Healthpac Inc.
• Experience with HMO Medical insurance claims and have a clear understanding of coding requirements ie: CPT and ICD codes and medical terminology.
• Intermediate to advanced understanding of Microsoft Office products ie: Excel Word Access etc.
• Able to problem solve exercise initiative and make low level decisions.
• Thorough understanding of claims processing and dispute compliance requirements.
• Ability to meet deadlines and prioritize tasks with the manager oversite.
• Ability to work independently with minimal supervision.
• Effective written and oral communication.

Additional Information :

The base pay for this role is $60000.00

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth our values come to life in everything we do. 

• We are Driven by Accountability grounded in transparency reliability and integrity as we navigate challenges and opportunities alike. 
• Always Growing Always Learning staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation we solve problems creatively making every experience better for our employees and the patients we serve. 
• At Guidehealth Every Voice Matters we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth. 

BENEFITS:

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical Dental and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those just in case moments. Additionally we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include but are not limited to: skill set years of relevant experience education location and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment. 

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles the responsibilities would be further defined by the hiring manager. 

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 50 mbps download 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.

Remote Work :

Yes

Employment Type :

Full-time