Managed Care Training Class

Proposal

Tanya Silvia
CUR/516
01/29/16
Shirley Burnett

Welcome

Why do we need Managed Care

Training?
How will this benefit the company?
Why train this topic now?
How do we select trainees?
What is going to be addressed?
How will class be implemented?
What do we need to teach the class?
How will we measure success?
When can we implement the class?

Why do we need Managed Care

Training?

To meet or exceed health provider

expectations for timely payments.

Stay within contract agreements with health

care providers.

Catch up on old claims inventory.

Finalize claims quickly.

Reduce health provider concerns, complaints,

and calls asking for claim payment status.

How will this benefit the company?

Happier medical providers who will continue

to accept our insurance.

No fees for late payments.

Faster reduction in claims volume.

Enough qualified staff to process claims

daily.

Reduce overtime costs to hourly employees.

Why train this topic now?

30,000+ claims in the system, many

over 30 days old.

Inventory growing daily by 1,0002,000 new claim receipts.

High overtime costs.

Fees being accessed daily for late

claim processing.

Small amount of qualified processors.

How do we select trainees?

4-12 Years of claims processing experience.

Good attendance.

Level 2 & 3 processors with low error scores.

Processors with strong systems knowledge.

Processors that currently meet or exceed

daily reasonable expectation processing
guidelines.

Processors that want to learn something new.

What is going to be addressed?

Continued

Product knowledge.

Comparison of plans affected by

managed care.

More challenging system usage.

Attention to detail.

How to improve research skills.

What is going to be addressed?

Improving the quality of managed

care claim processing.

Learning to understand and decipher

complex directions.

Making sound judgement calls.

Encouraging speaking with subject

matter experts for complex
decisions.

Looking for trends that are slowing

down processing.

How will class be implemented?

Continued

Trainers and Assistants will work with

trainees closely and watch for learning
barriers.

All newly revised materials will be presented.

Flexibility with material presentation will be

built in class schedule.

Sample claims will be obtained daily by

trainer.

Trainer will walk trainees through processing

complex claims.

How will class be implemented?

Q&A sessions will happen each day in

the classroom setting.

Quizzes and games will be conducted to

enhance learning in a fun way.

Claims complexity will change each day,

growing from easier to harder claims.

Hands-on experience.

Full audit support from claims Quality

Control.

Implementation phase 1

The facilitator will have the students sign

into the training system upon arrival. The
students will then be given a syllabus
outlining the class expectations and
timeframes for each topic. A brief review
of various insurance policy offerings will
be discussed.

Managed care overview will begin and

students can take notes. The trainers
computer screen will be set up so it can
project the image on a whiteboard.
Simple claims will be reviewed then;
questions will be answered and asked by
the instructor as needed.

Implementation phase 2

The objectives use project-based learning and

critical thinking skills. Project based learning
consists of learners working on individual claim
as its project.

Critical thinking skills are utilized to figure out

what went wrong with the claim and why.
Identifying system errors and trends while
processing, helps to minimize backup of
incoming claims.

The position of a managed care processor is an

individual based processing and flexibility is
needed because each claim carries its own
issues. Critical thinking skills allow the students
to look at key items and see how they interact
with each other.

Implementation phase 3

Activities like quizzes, vocabulary building

games, such as vocabulary bingo where the
student gets a small prize and visual shows via
projector will be used.

Addition of problem-based claims from lower

level errors to claims with multiple problems will
be obtained before classes start so that they can
be pinpointed for class discussion and questions.

Hands-on approach to the computer training

mode will allow for further activities. This option
gives each student to work on the problem
claims individually and then be discussed
together in the class to find the right conclusion.

Implementation phase 4

Review claims with the class that were

found to be processed incorrectly

Explain why they were processed

incorrectly and what to do in the future

Encourage students to keep newly

established relationships with SMEs
for further advice

Final accuracy testing of processing

pre-selected claims

What supplies do we need to teach the

class?

Use of a training room for six weeks.

Twelve desks, working computers, mouses that

work.

Notebooks and pens along with a dry erase

board and projectors are needed. Dry erase
board pens and erasers are needed.

Poster board and markers will be needed to

make signs with important points for the course
are needed. Large paper pads will be needed
to keep a list of questions to be answered.

PowerPoint software is also needed.

How will we measure

success?

The criteria for determining whether goals,

objectives, and final outcomes are met will
be conducted by testing of the
participants.

Also, an overall class result quiz will be

implemented in the final stages of the
training class.

A small short test giving specific examples

in which the learner has to complete four
out of five scenarios correctly will be
implemented in the program.

Processors will need to demonstrate

successful processing of at least 18 claims
per hour.

When can we implement the class?

The anticipated start date is

March 29, 2016.

The total length of time for

this course is six weeks,
five days a week from 8:00
AM 2:00 PM.

Conclusion

Managed care claims processing training is necessary

for associate development. Managed care processes
are challenging but are attainable, as stated by
associates already processing them. Subject matter
experts agree that with the addition of new associates
to the managed care associate team will help
streamline claims.

Changes in claims processing happen quite often, but

with proper feedback and training lessons, our
company can keep up with the demand. This will
increase the probability that higher volumes of
managed care claims will decrease steadily.

Questions?

References

Anderson, L. W. & Krathwohl, D. R. (2001). A

Taxonomy for learning, teaching, and assessing
http://
www.colorado.edu/sei/documents/Workshops/Han
douts/Blooms_Taxonomy.pdf

Colosi, L.(2006).Designing an Effective

Questionnaire. Retrieved
fromhttp://www.human.cornell.edu/pam/outreach
/parentin g/parents/upload/Designing-20an20Effective-20Ques tionnaire.pdf