Hawaii Medical Service Association Quality Assurance Trainer - Medical in Honolulu, Hawaii

Company:Hawaii Medical Service Assn.Job Title:Quality Assurance Trainer - MedicalExempt or Non-Exempt:Non-ExemptIsland:OahuCity:HonoluluLocation:HonoluluEmployment Type:Full TimeJob Summary:The (Quality Assurance) QA Trainer-Medical conducts audits and provides training, assesses employees’ skills based on audit results and performance training and makes recommendations to supervisors and managers based on these assessments. An employee in this position provides support to the Supervisor on the day-to-day operations of the production unit.Duties and Responsibilities:

  • a. 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.

  • Provides coaching and/or mentoring to examiners at all levels. Acts as a resource to Benefits Examiners, Batch Control Clerks 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.

  • Identifies and provides resolution to claims 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 examiner 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.

  • Assists supervisor in daily unit operations including but not limited to:

  • Assigning work to examiners based on examiner 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.

  • Other duties as assigned.

Minimum Qualifications:

  • Associate’s (AA) degree or one (1) year as a Benefits Examiner Level III or equivalent combination of education and work experience.

  • Prior experience in healthcare industry.

  • Prior experience in training or auditing other people

  • Good working knowledge of Microsoft Office applications

  • Work Hours: Some weekends determined by HMSA’s business needs.

EEO/AA/Disability/Vets Employer