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Job Title:

SHP Claims Training & Audit Manager (Hybrid Remote)

Cost Center:

682891379 SHP-Claims

Scheduled Weekly Hours:

40

Employee Type:

Regular

Work Shift:

40 Normal (United States of America)

Job Description:

JOB SUMMARY

The SHP Claims Training and Audit Manager is responsible for managing Claims Department training & auditing staff. Responsible for overseeing delivery of quality training services and documentation support, which includes, but is not limited to: Desk Level References (DLRs) and Policies and Procedures (P&Ps) for all teams within the Security Health Plan (SHP) Claims Department. Identify and assess training needs across all Claims Department teams. Research and develop training programs for SHP, primarily claims. Develop methods and design materials for training staff. Communicate functions of claim operations roles to insure associates are current on changing processes or government regulations. Responsible for establishing and maintaining the policies and guidelines for auditing claims, reporting and trending of audit results and managing the activity of the auditors. Must remain current in the content areas that fall within the training department’s responsibility. They will collaborate with other SHP areas for internal or external claim education, as needed. Must be familiar with state and federal guidelines, and mandates. Act as a resource for personnel, both within and external to the claim department regarding all SHP product lines. Identify process improvement opportunities utilizing training and audit processes. Has overall responsibility for all day-to-day functions within the training & auditing team, to include personnel actions within the team. Works closely with the Director of Operations to assure effective management of the Claims Department.

JOB QUALIFICATIONS

EDUCATION

For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.

Minimum Required: Bachelor's degree in education, business or a related field required, however, significant experience may substitute. Business or medical background, including information systems knowledge, preferred. Medical Terminology, Anatomy & Physiology, CPT/HCPCS and ICD-9 coding are required. Intermediate level of Word, Excel and PowerPoint required, knowledge of Access.

Preferred/Optional: None

EXPERIENCE

Minimum Required: Minimum of 5 years in the health insurance industry required. Minimum of three years technical experience (hands-on working knowledge) in SHP claims. A complete and detailed knowledge of all aspects of the Claims department, as well as a functional knowledge of other Operational areas of SHP. Intimate working knowledge of SHP applications required. Must have strong analytical and problem solving skills, a high level of creativity, and excellent oral and written communication skills.

Preferred/Optional: Prior experience in the management of health claims operations. Prior experience instructing or training adults.

CERTIFICATIONS/LICENSES

The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.

Minimum Required: None

Preferred/Optional: Certified Professional Coder.

Hybrid Remote Work Environment requiring 2-3 days onsite

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

At Marshfield Clinic Health System, we are fully committed to addressing health equity, diversity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every individual should have the opportunity to attain their highest level of health. We embrace diversity and welcome differences in who we are and how we think. We believe that any individual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here (https://www.marshfieldclinic.org/mAboutUs/Documents/30922-000_Equity-and-Inclusion-Statement%20%282%29.pdf) .

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program .

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

We’re hiring! Use “remote” or “hybrid” as a keyword in the search to see our remote-eligible openings!

When given the tools needed to excel, great things happen: connection with colleagues, recognition in the community, better care for our patients. All this is available with affordable living rich in leisure. Welcome to Marshfield Clinic Health System . Where career meets community.

Positions listed as 30 hours per week or greater are offered the level 1 benefit package.

Positions listed as 20 – 29 hours per week are offered the level 2 benefit package.

Positions listed as less than 19 hours per week are non-benefited.

Benefits for temporary positions vary. Details will be discussed in the interview process.

At Marshfield Clinic Health System, we are fully committed to addressing health equity, diversity and inclusion for our employees and providers, our patients, and the communities we serve.

We believe that every individual should have the opportunity to attain their highest level of health. We embrace diversity and welcome differences in who we are and how we think. We believe that any individual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here (https://www.marshfieldclinic.org/mAboutUs/Documents/30922-000_Equity-and-Inclusion-Statement%20%282%29.pdf)