Accessing, Navigating, and
Utilizing Benefit Systems
Kelly Carnevale
CUR/516
April 6th 2014
Professor Shirley Burnett
Course Description
• Horizon Behavioral Health, managed health care,
provides behavioral health services to millions of
people all over the United States. These people rely on
these health services, usually when they need them
the most, to ensure appropriate, correct, and timely
application of their health care benefits. For this
reason, it is imperative that employees of Horizon
Behavioral Health be able to access, navigate, and
utilize benefit systems. This course will aim to train
employees on accessing and identifying information
that is needed to complete documentation according
to workflows and on understanding process and
workflow of entering the documentation.
Who is this Training for?
• Existing employees of Horizon Behavioral
Health who have an interest in further
developing their work skills.
• Newly hired employees who need to learn the
ins and outs of documentation, benefit
research, and application systems.
• Existing Employees who have exhibited
deficiencies in using the
application systems.
How will this Training be Delivered?
• This training can be offered in person at the
Mt. Laurel corporate location.
• A Go-to-Meeting account will also be created
to allow employees from other locations to
access the training course.
• It will be a one-week intensive training that
provides in-depth learning through
presentations, group discussions,
and individual practice.
Why is Training Needed?
• After conducting a needs and performance analysis, it
was concluded that there are many errors made by
current employees when using the application systems.
• Employees have well-rounded clinical experience and
knowledge, however they lack experience with the
application systems and need further training in order
to effectively and ethically provide services to
members.
• Despite the team that works each day to correct errors
in documentation and forms, the number of reported
errors continues to rise. Therefore, more in-depth
training is needed for new-hires for efficient skill
retention and is needed for existing employees to build
on skills to reduce error margins.
Training Goals
• The goals of this training will include:
– Employees will be able to access and identify
information needed to complete documentation
in accordance with established workflows and
company policy.
– Employees will understand the process and
workflow of entering documentation and
completing forms correctly in the designated
application systems in order to avoid major costs
to the company, client, and individual employee.
Training Objectives
• Goal #1 Objectives:
– The employee will be able to login to the application systems,
given system access and login training, and navigate to find the
needed information without assistance.
– The employee will be able to translate the information, given
insurance information templates, within the application systems
and be able to verbally explain it to providers nine out of ten
times without error.
• Goal #2 Objectives:
– The employee will be able to verbally explain the process and
workflow, given a practice case study, of how to enter the
documentation into the appropriate forms without error.
– The employee will be able to identify errors in previously
completed documentation that was not entered correctly into
the system, given an error list, nine out of ten times without
error.
Instructional Strategies
• This training will utilize project-based learning.
– During the group training sessions, employees will
work together as a team to work the case studies
according to established work flows.
– Individually, employees will practice with case
studies and get hands on experience with the
application systems.
Instructional Strategies Continued
• This training will also focus on the development
of critical thinking skills.
– Work flows change depending on the circumstances
of each case, therefore employees will need to utilize
critical thinking skills to independently navigate
barriers.
– IDEALS strategies will be incorporated to foster critical
thinking skills. Employees will be assigned activities
that will prompt them to identify problems, define the
context, enumerate the choices, analyze the options,
list reasons, and self correct so as to develop the
critical thinking skills necessary to complete the
workflows (Snyder, 2015).
Instructional Activities and
Technologies
• Employees will engage in group discussions
that involve summarizing main points and
concepts, sharing opinions, asking questions,
testing concepts and ideas, and self-assessing
their learning (Snyder, 2015).
• This course will utilize computers, application
systems, go-to-meeting sessions, and
PowerPoint presentations.
Implementation
• The projected start date for this training
session is April 20th 2014. The training session
would then end on April 24th 2014.
• Please see Figure 1.1 on the next slide for an
implementation schedule.
Accessing, Navigating, and Utilizing Benefit Systems:
Training Schedule
Monday
Tuesday
Wednesday
Thursday
Friday
9:00 AM
Welcome and
Introductions
Brief Refresher of
Authorization System
Brief Refresher of
Eligibility System
Brief Refresher of
Benefit System
Recap of the Week
10:00 AM
Break (10minutes)
Break (10minutes)
Break (10minutes)
Break (10minutes)
Break (10minutes)
10:10 AM
11:10 AM
Overview of Schedule
Review of workflow
Review of workflow
Questions
Break (10minutes)
Break (10minutes)
Break (10minutes)
Introduction to
Systems
Observation of Workflow
Completed by Trainer
Observation of
Workflow Completed
By Trainer
Observation of
Workflow Completed
by Trainer
Practice
12:30 PM
Lunch (30 minutes)
Lunch (30 minutes)
Lunch (30 minutes)
Lunch (30 minutes)
Lunch (30 minutes)
1:00 PM
Importance of
Proficiency in Systems
in Regard to Clinical
Usage
Specific Application to
Clinical Usage
Specific Application to
Clinical Usage
Specific Application to
Clinical Usage
Practice
Break (10minutes)
Break (10minutes)
11:20 AM
2:00 PM
2:10 PM
Break (10minutes)
Review of workflow
Break (10minutes)
Overview of System
Functions
Break (10minutes)
Practice
Break (10minutes)
Practice
Break (10minutes)
Practice
Break (10minutes)
Break (10minutes)
Break (10minutes)
Testing
3:10 PM
Break (10minutes)
Break (10minutes)
3:20 PM
Practice Logging into
Each System
Practice and Self-Paced
Assessment
Practice and SelfPaced Assessment
Practice and SelfPaced Assessment
Testing
4:30 PM
Daily Conclusion
(15minutes)
Daily Conclusion
(15minutes)
Daily Conclusion
(15minutes)
Daily Conclusion
(15minutes)
Daily Conclusion
(15minutes)
Implementation Facilitator and
Materials
• Facilitator- The main facilitator of this course will
be the clinical trainer and the systems trainer
from Mount Laurel New Jersey.
• Materials- Each employee will need to be
equipped with a computer and access to each
system that they will be trained on. The
facilitator will utilize handouts for reference
sheets and workflows. PowerPoint presentations
will also be developed. A Go-to-Meeting line will
be provided for each session as well for those
employees who are not in the host location.
Implementation Details
• Building Interest- Once approved, an email will be
distributed to all employees introducing the purpose of the
training as well as the dates that it will be offered.
Managers should encourage employees who experience
difficulties in navigating the systems to attend the training.
• Selecting Participants- All interested employees may
choose to attend the training. New hires and employees
expressing difficulties will be required to attend the
training.
• Formative Assessments- Employees
will be assessed based on
observations, a practical test at the
end of the training week, and self
assessments.
Evaluation Criteria
• Criteria- Employees will need to meet the objectives by
completing the workflows with little to no error.
Overall, the criteria for determining successful training
will be 8 out of 10 employees can complete the
workflows, with little to none, one on one assistance.
• Evaluation Instruments- A program will need to be run
that identifies errors in the practice documents. This
will be used to analyze progress from the beginning of
the training course until the end. This data will then
need to be organized in an excel workbook so that
future testing can be compared to end of training
testing.
Conclusion
• Employees who participate will develop the skills
necessary to produce quality services while
minimizing the hassle and frustration some
customers experience.
• This training and its results will also allow for
additional data that correlates to the
performance guarantees in your contract.
• By approving this training, you will be approving
the opportunity to provide better care and
services to your customers.
References
• Snyder, M. (2015, January 1). Critical Thinking:
Teaching Methods & Strategies. Retrieved
April 4, 2015, from
https://www.spfk12.org/cms/lib07/NJ010015
01/Centricity/Domain/15/HANDOUT__Critical_Thinking__Teaching_Methods_and_Strategies.doc