Job Description

Training Specialist Qualifications

Department: Care Management Services (CMS)

Education

• Bachelor's degree in Healthcare Administration, Nursing, Business, Health Information Management, or related field preferred.

Experience

• Minimum 2 to 3 years of healthcare operations experience.
• At least 1 year of Quality Assurance, Auditing, Compliance, or Performance Improvement experience.
• Experience auditing Enrollment, Eligibility Verification, Insurance Validation, and Care Management workflows.
• Experience conducting root cause analysis and calibration sessions.

Technical Knowledge

• Knowledge of:
• Medicare and Medicaid guidelines
• Commercial insurance verification standards
• Healthcare documentation requirements
• Care Management workflows
• HIPAA and confidentiality standards
• Strong analytical and reporting skills.

Core Competencies

• Attention to detail
• Critical thinking
• Data analysis
• Coaching and feedback delivery
• Process improvement
• Risk identification
• Stakeholder management
• Strong written communication

Key Responsibilities

• Audit transactions, calls, cases, and documentation.
• Perform quality reviews against SOPs and client standards.
• Conduct calibration sessions with operations and training teams.
• Identify trends and performance risks.
• Provide coaching recommendations.
• Develop QA scorecards and audit tools.
• Track compliance and productivity metrics.
• Partner with Operations leadership to improve quality outcomes.

Preferred Metrics Experience

• Quality scores
• Audit accuracy rates
• Compliance adherence
• Error reduction trends
• Corrective action effectiveness
• Process improvement initiatives

Preferred Leadership-Level Competencies

Required

• Healthcare BPO or Healthcare Operations experience
• Strong understanding of Enrollment & Eligibility functions
• Knowledge of Care Management Services workflows
• Advanced Excel and reporting skills
• Project management capabilities
• Experience creating and maintaining SOPs

Preferred

• Lean Six Sigma Yellow Belt or Green Belt
• Certified Professional in Healthcare Quality (CPHQ)
• Certified Trainer designation
• Experience building quality and training programs from the ground up