Provider Claims Training Specialist - San Diego, CA - Remote (Rancho Cucamonga,

Summary

The Provider Claims Training Specialist also known as Regional Representatives, support the provider community in a variety of areas including but not limited to virtual and onsite visits, claims follow up and research support, as well as virtual and face-to-face training development and delivery. These positions act as liaisons between providers and internal departments. The appropriate individuals for these positions will possess strong communication skills, have experience delivering training in-person and virtually, and be available for limited overnight travel. These positions work with providers, provider associations, and directly with the client in support of the Medi-Cal program.

Your role in our mission

• Under minimal supervision, performs routine to complex tasks that are related to provider claiming, program policies, and training.
• Provides training (workshops, seminars, program specific group events) to the provider community and acts as liaison with our internal departments and the customer to implement programs that are necessary for the Medicaid program.
• Provides one-on-one billing support, claim research and analysis, and targeted outreach to providers; supports provider association inquiries and events
• Applies knowledge of established policies and procedures to resolve provider issues, and to work with the customer to ensure compliance.
• Exercises independent judgment within defined practices and procedures to define appropriate actions; escalates areas of concern to leadership/the client as defined by procedures; evaluates unique circumstances and makes recommendations.

What we're looking for

• Three or more years of medical claims processing or provider billing experience, including working knowledge of CMS-1500 and UB-04 claim forms.

• Hands-on experience researching, resolving, and educating providers on claim submission, denials, and reimbursement processes; Medi-Cal or Medicaid experience preferred.

• Strong analytical, organizational, and time management skills, with proven ability to manage multiple provider requests efficiently.

• Excellent communication, presentation, and training skills for both virtual and in-person settings, with a focus on simplifying complex billing and policy topics.

• Willingness and ability to travel within the assigned region to conduct provider visits, outreach events, and training sessions.

What you should expect in this role

• Work from Home, in the San Diego area
• Travel required throughout the assigned geographic region to support training and other provider and account needs.
• For positions assigned to WFH, reliable high-speed internet connectivity is required.  Employees working-from-home may be required to report to the office, at times, to support work efforts.

This posting is intended for pipelining. We will accept applications on an ongoing basis.