http://www.amerigroup-jobs.com/feeds/Medical-Billing-Coding-Atlanta-GA-jobs/ Custom RSS Feed for Medical-Billing-Coding-Atlanta-GA-jobs Sun, 26 May 2013 07:09:05 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/feeds/Medical-Billing-Coding-Atlanta-GA-jobs/ 720
Job ID 2013-22385 # Positions 1
Location US-GA-Atlanta
Search Category Finance
Type Regular Full-Time (30+ hours) Posted Date 5/2/2013
Additional Locations ..

More information about this job:
Summary:

Work directly with Plan and Corporate Office customers and business owners to provide analytical reporting and solutions in support of Medical Cost and Trend Analysis, Medical Expense Initiatives (MEIs), Financial Reporting, Quality Analysis and the development, accomplishment and measurement of strategic initiatives. This requires strong analytical thinking and a thorough understanding of analytical tools, analytic techniques, data nuances, and methodologies.

Responsibilities:

1. Produces, analyzes and maintains reports used to measure, monitor and manage quality of care and service as well as other financial analysis.

2. Utilizes knowledge of databases, information systems, statistical tools and analytical principles to analyze outcomes that support strategies for managing health plan performance.

3. Compiles and analyzes data including quality indicators, performance scorecard and quality improvement activities.

4. Performs statistical tests to determine statistical significance, confidence level, validity and reliability of outcome.

5. Supports systems to provide trended data related to State required clinical outcomes measures.

6. Assists in the development of databases and analysis tools to measure clinical outcomes and prevention initiatives.

7. Develops, standardizes, maintains and enhances reports for State quality reporting.

8. Participates in clinical focus study development, data collecting and analysis.

9. Trends quarterly data and develops aggregate and individual data reports.

10. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree in business, science, healthcare or related field.

Years and Type of Experience Required:

Required:
- Minimum 3 years data or finance analysis or statistical experience.

Preferred:
- Previous HMO/Managed Care industry experience preferred.

Specific Technical Skills

Required:
- Proficient with window based environment software tools.
- Stung Microsoft Excel and Access skills.
- Working knowledge of information systems including database design.

Preferred:
- Knowledge of SPSS.
- Understanding of ICD-9 and CPT coding system and claims helpful.

Other:

Required:
- Excellent analytical skills.
- Attention to detail.
- Excellent organizational skills; the ability to handle multiple priorities simultaneously with a high quality result.
- Appreciation of cultural diversity towards target population.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to operate a calculator.

CB2

ermCorp
]]>Wed, 22 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Atlanta-Finance-Analyst-Job-GA-30301/2504226/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Atlanta-Finance-Analyst-Job-GA-30301/2504226/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22927 # Positions 1
Location US-NATIONWIDE
Search Category Medical Coding
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

Provide development and maintenance of rules, policies and procedures, and educational processes focused on ensuring organizational compliance with industry standard coding practices. Interpret and apply National Uniform Billing Compliance rules, guidelines, laws and industry trends to support, provider reimbursement, system configuration and ongoing provider education. Proactively address cost efficiencies and compliance requirements. Recommend clinical classification and reimbursement guidelines and standards. Review coding in provider contracts and participate in development of coding standards for provider contracts.

Responsibilities:

1. Provides development and maintenance of rules, policies and procedures for coding and reimbursement based upon an extensive understanding of current guidelines and trends (i.e. coding for non-covered, exceptions, capitation, state and federal mandates regarding coding). This also includes state and federal communication media related to coding and cross-walks, industry standard code sets (i.e. CPT, HCPCS, Revenue, ICD.9, DRG, etc.), and medical compliance and reimbursement policies such as medical necessity issues and proper coding.

2. Conducts internal coding reviews and/or audits as required. Review and validate coding related to provider billing, contracts, rate sheets etc. Provide recommendations for development of standards.

3. Provides technical guidance for configuration coding to the Business Configuration department. Assist in the resolution of provider reimbursement configuration or claims payment issues as needed.

4. Implements and manage applications and processes for clinical classification and coding of health care services.

5. Correlates findings with appropriate actions including but not limited to provider education, cost recovery, cost avoidance, policy and coverage guidelines.

6. Assists in evaluation, design and implementation of strategies to send communication to providers who are billing out of normal ranges. Strategies include training provider, monitoring impact, responding to inquiries, calls etc.

7. Interfaces with operational department management on industry standards and National Uniform Billing Compliance issues.

8. Actively develops and participates in training activities related to coding.

9. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in Health Care Management, Accounting, Business or equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Minimum of 3 years coding experience in health care setting (ICD-9, CPT-4, E&M, HCPCS, DRG and Revenue).

Preferred:
- Experience in health insurance reimbursement, medical billing, medical coding, auditing, or health data analytics setting preferred.

Certifications or Licensures

Required:
- AAPC (CPC) or AHIMA coding certification (CCS). Must maintain licensure, i.e. completion of annual continuing professional education requirements.

Language Skills

Required:
- English

Functional Competencies

Required:
- Experience in analysis in health care utilization, clinical or managed care environment.
- Extensive knowledge and understanding of healthcare industry coding theory, rules and standards (such as CPT, HCPCS, Revenue, ICD9, DRG, etc).
- Advanced understanding of medical terminology, body systems/anatomy, physiology and concepts of disease.
- Ability to perform research and develop policies and procedures and recommendations.
- Ability to analyze contracts, regulations, policies and procedures, reports and legal documents.

Preferred:
- Previous experience auditing professional and/or facility coding preferred.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>Wed, 22 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Medical-Coding-Analyst-%28position-located-in-Virginia-Beach%2C-VA-or-Nashville%2C-TN%29-Job/2611282/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Medical-Coding-Analyst-%28position-located-in-Virginia-Beach%2C-VA-or-Nashville%2C-TN%29-Job/2611282/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22662 # Positions 1
Location US-NY-New York
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/24/2013
Additional Locations ..

More information about this job:
Summary:

Provide development and maintenance of rules, policies and procedures, and educational processes focused on ensuring organizational compliance with industry standard coding practices. Interpret and apply National Uniform Billing Compliance rules, guidelines, laws and industry trends to support, provider reimbursement, system configuration and ongoing provider education. Proactively address cost efficiencies and compliance requirements. Recommend clinical classification and reimbursement guidelines and standards. Review coding in provider contracts and participate in development of coding standards for provider contracts.

Responsibilities:

1. Provides development and maintenance of rules, policies and procedures for coding and reimbursement based upon an extensive understanding of current guidelines and trends (i.e. coding for non-covered, exceptions, capitation, state and federal mandates regarding coding). This also includes state and federal communication media related to coding and cross-walks, industry standard code sets (i.e. CPT, HCPCS, Revenue, ICD.9, DRG, etc.), and medical compliance and reimbursement policies such as medical necessity issues and proper coding.

2. Conducts internal coding reviews and/or audits as required. Review and validate coding related to provider billing, contracts, rate sheets etc. Provide recommendations for development of standards.

3. Provides technical guidance for configuration coding to the Business Configuration department. Assist in the resolution of provider reimbursement configuration or claims payment issues as needed.

4. Implements and manage applications and processes for clinical classification and coding of health care services.

5. Correlates findings with appropriate actions including but not limited to provider education, cost recovery, cost avoidance, policy and coverage guidelines.

6. Assists in evaluation, design and implementation of strategies to send communication to providers who are billing out of normal ranges. Strategies include training provider, monitoring impact, responding to inquiries, calls etc.

7. Interfaces with operational department management on industry standards and National Uniform Billing Compliance issues.

8. Actively develops and participates in training activities related to coding.

9. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in Health Care Management, Accounting, Business or equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Minimum of 3 years coding experience in health care setting (ICD-9, CPT-4, E&M, HCPCS, DRG and Revenue).

Preferred:
- Experience in health insurance reimbursement, medical billing, medical coding, auditing, or health data analytics setting preferred.

Certifications or Licensures

Required:
- AAPC (CPC) or AHIMA coding certification (CCS). Must maintain licensure, i.e. completion of annual continuing professional education requirements.

Language Skills

Required:
- English

Functional Competencies

Required:
- Experience in analysis in health care utilization, clinical or managed care environment.
- Extensive knowledge and understanding of healthcare industry coding theory, rules and standards (such as CPT, HCPCS, Revenue, ICD9, DRG, etc).
- Advanced understanding of medical terminology, body systems/anatomy, physiology and concepts of disease.
- Ability to perform research and develop policies and procedures and recommendations.
- Ability to analyze contracts, regulations, policies and procedures, reports and legal documents.

Preferred:
- Previous experience auditing professional and/or facility coding preferred.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermCS
]]>Thu, 23 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/New-York-Medical-Coding-Analyst-Auditor-CPC-Certified-Job-NY/2564575/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/New-York-Medical-Coding-Analyst-Auditor-CPC-Certified-Job-NY/2564575/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22937 # Positions 1
Location US-GA-Atlanta
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute care and post-discharge, in collaboration with the member.

3. Utilizes pre-approved criteria and guidelines to validate medical necessity of continued stay and appropriateness of treatment and discharge planning.

4. Acts in conjunction with the appropriate manager(s) on a daily basis to assess the inpatient census for appropriate alternative health care service needs.

5. Coordinates with appropriate discharge planning team members, facility utilization management department, physicians and members to coordinate timely discharges.

6. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. Acts in conjunction with the clinical team related to discharge planning (e.g., home care, hospice care, rehabilitation care, special program care, transitional care, occupational therapy, speech, respiratory and physical therapy), durable equipment and disposable supplies.

8. Documents all activities in the appropriate system(s) on a timely basis.

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of three years experience in health care, case management, discharge planning, utilization management, or behavioral health.
- Experience working on the community level and with community agencies.

Certifications or Licensures

Required:
- LPN, LVN or LSW (depending on health plan needs or as mandated by state contract).
- Must possess a valid driver’s license and access to a motor vehicle.
- For Behavioral Health Dept/Specialty Requirements only: LMFT, LPC, LCSW.

Preferred:
- Certified Professional Healthcare Management.

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>Wed, 22 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Atlanta-Utilization-Manager-Job-GA-30301/2611292/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Atlanta-Utilization-Manager-Job-GA-30301/2611292/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22141 # Positions 1
Location US-VA-Norfolk
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 3/14/2013
Additional Locations ..

More information about this job:
Summary:

Provide leadership and expertise in development and maintenance of rules, policies, procedures and educational processes focused on ensuring organizational compliance with industry standard coding practices. Interpret and apply National Uniform Billing Compliance rules, guidelines, laws and industry trends to support accurate provider reimbursement, system configuration, and ongoing provider education. Proactively address cost efficiencies and compliance requirements. Recommend clinical classification and reimbursement guidelines and standards.

Responsibilities:

1. Reviews claims and medical records routed to the department for billing/coding compliance issues; prepares and submits audit findings to appropriate individuals.

2. Correlates findings with appropriate actions including but not limited to provider education, cost recovery, cost avoidance, policy and coverage guidelines.

3. Coordinates findings and actions with Health Plan Medical Director, Provider Relations and other appropriate staff.

4. Assist in the development of departmental policies and procedures regarding documentation and coding standards. Make coding policy recommendations based upon current trends in code theory and interpretation, industry standard coding, billing practices, state contract language (i.e. CPT, HCPCS, Revenue, ICD.9, DRG, etc), medical compliance and reimbursement policies, such as medical necessity issues and proper coding.

5. Assists in evaluation, design and implementation of strategies to send communications to providers who are billing out of normal ranges.

6. Develops appropriate processes and case documentation to support the mission of the department. Present reimbursement coverage recommendations to Reimbursement and Clinical Policy Committees.

7. Provides technical oversight of coding review resources by the medical coding team. Evaluate coding on provider contract rate sheets. Perform quality assurance functions and rate sheet reviews for code recommendations.

8. Creates and maintains code sets used for configuration in benefits & pricing and other sub-systems. Changes to approved code sets are updated accordingly.

9. Ensures all contracts are properly configured in the appropriate business systems for accurate adjudication and reporting. Assists in the resolution of provider contract configuration or claims payment issues identified in the home office or the plans as needed.

10. Interfaces with operational department management, Health Plans and State representatives on industry standards and National Uniform Billing Compliance issues.

11. Assists in provider, provider office staff and Amerigroup staff education process related to medical code assignments, national coding initiatives, industry standards and required documentation.

12. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in Health Care Management, Accounting or Business, or equivalent experience in lieu of degree(s).

Years and Type of Experience Required:

Required:
- Minimum of 6 years coding (ICD-9, CPT-4, E&M, HCPCS, DRG and Revenue) experience with a minimum of 2 years experience in claims, clinical or managed care environment.
- Previous experience auditing professional fee coding.
- Previous experience providing physician training and education for E&M coding.

Certifications or Licensures

Required:
- AAPC (CPC) or AHIMA (CC) coding. Must maintain licensure, i.e. completion of annual continuing professional education requirements.

Preferred:
- Licensed Practical Nurse (LPN) or Registered Nurse (RN)

Language Skills

Required:
- English

Functional Competencies
- Intermediate to advanced level MS Office skills.
- Advanced understanding of medical terminology, body systems/anatomy, physiology and concepts of disease.
- Ability to analyze, interpret and summarize contracts, regulations, policies and procedures, reports and legal documents.
- Ability to respond to questions/concern from internal/external customers and regulatory agencies and present company position in understandable and unambiguous manner.
- Prior claims processing system knowledge preferred.
- Ability to apply creative/breakthrough methodologies and thinking to the tasks.
- Strong communication skills, both written and verbal; articulate, persuasive & influential; systematic and timely.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermCS
]]>Sat, 11 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Norfolk-Sr-Medical-Coding-Analyst-Job-VA-23501/2480267/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Norfolk-Sr-Medical-Coding-Analyst-Job-VA-23501/2480267/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22923 # Positions 1
Location US-GA-Atlanta
Search Category Human Resources
Type Regular Full-Time (30+ hours) Posted Date 5/21/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for the development and delivery of initial and ongoing technical and professional skills training programs, with emphasis in the VA Medical Management department and in the Plans.

Responsibilities:

1. Principal liaison to Virginia Beach and Health Plan medical management departments.

2. Work closely with business partners.

3. Develop, implement and deliver training programs utilizing adult learning theories and principles.

4. Monitor key business indicators in order to identify training needs.

5. Utilize appropriate methods, techniques, and equipment.

6. Monitor effectiveness of programs and progress of trainees.

7. Support business operations.

8. Partner with plan associates to ensure training and development needs support key business objectives.

9. Provide feedback to business partners regarding challenge areas to improve productively and procedures.

10. Utilize superb platform skills to present technical information effectively in a classroom setting, one on one or using distance learning technology.

11. Other special projects and duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- College degree or equivalent experience.

Preferred:
- Bachelor’s or Master’s degree; training certification.

Years and Type of Experience Required:

Required:
- Managed Care Experience.
- 3-5 years training experience; technical training considered a plus. Training experience includes 1:1 training, SME experience, mentor, preceptor, classroom, etc. Does not need to be in an official training capacity.

Preferred:
- Case Management and/or Utilization Management experience or certification desirable.
- Training experience, preferably in health care.
- Technical background considered a plus.

Specific Technical Skills

Required:
- Working knowledge of Microsoft Office applications.

Certifications or Licensure

Required:
- LPN

Preferred:
- RN
- Training or managed care certification highly desirable.

Other:

Required:
- Capable of managing multiple, simultaneous projects.
- Demonstrated ability to succeed in a fast-paced, constantly changing environment.
- Appreciation of cultural diversity and sensitivity towards target population.
- Ability to become a subject matter expert in a variety of topics.
- Demonstrated ability to interface with employees and customers with a high degree of tact and diplomacy.
- Ability to meet company travel requirements.

Preferred:
- Healthcare information systems experience highly desirable.

Travel – Technical Trainers Up to 30%

Travel – Case Management / CarePlus Trainer May require up to 100%

PHYSICAL REQUIREMENTS
- Must be able to operate computer, phone and general office equipment.
- Must be able to travel as required using common carriers and adhere to AGP’s travel policies.

ermCorp
]]>Tue, 21 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Atlanta-Clinical-Trainer-Job-GA-30301/2609153/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Atlanta-Clinical-Trainer-Job-GA-30301/2609153/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22592 # Positions 1
Location US-GA-Atlanta
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective care management, utilization of health, mental health, and substance abuse services.

Responsibilities:

1. Manages and oversees teams responsible for various HCMS functions including utilization management, case finding and coordinating those cases that involve co-morbid conditions and need to be part of the case management/disease management track.

2. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.

3. Works with providers to establish short and long term goals that meet the member’s need, functional abilities and referral sources requirements.

4. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.

5. Coordinates the identifications of members with potential for high risk complications; assesses members’ present level of physical/mental impairment utilizing defined criteria and methodology.

6. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

9. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma or Associate’s Degree in related Health/Nursing/Social Work field.

Preferred:
- Bachelor’s Degree in related Health/Nursing/Social Work field or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of five years experience in health Care Management and at least one year of leadership/management experience.

Certifications or Licensures

Required:
- RN, PA, LSW, MSW, LPC, LCSW LMHC, or LPN/LVN
- Behavioral Health may also have LMSP in addition to any of the above.

Preferred:
- Certified Case Manager or Certified Utilization Review Professional.

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Strong communication skills, both written and verbal; articulate, persuasive & Influential; systematic and timely.
- Demonstrate project management experience in organizing, planning and executing large-scale projects from conception through implementation.
- Experience in leading and developing people.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>Tue, 14 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Atlanta-Manager-Health-Care-Management-Services-Job-GA-30301/2546965/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Atlanta-Manager-Health-Care-Management-Services-Job-GA-30301/2546965/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22140 # Positions 1
Location US-VA-Norfolk
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 2/28/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for reviewing medical records for claims submitted to Amerigroup which are potentially related to fraudulent or abusive billing practices. Work closely with all CID associates sharing knowledge, researching issues, documenting findings, drawing conclusions, and addressing issues with providers. Utilize a variety of resources to provide support for findings, keep informed of trends and changes in the medical field, and educate associates and providers. Work with Amerigroup Medical Directors to confirm findings, obtain guidance, and resolve issues relevant to CID investigations or department initiatives.

Responsibilities:

1. Performs all activities to identify, monitor and analyze aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment claims review and post payment auditing. Investigates potential fraud and over-utilization by performing complex medical reviews via prepayment claims review and post payment auditing.

2. Correlates review findings with appropriate actions (provider education, recovery of monies, cost avoidance, recommending sanctions or other actions).

3. Assists investigators by providing medical review expertise to accomplish the detection of fraudulent activities. Trains, educates, develops, and mentors other associates in the department.

4. Interfaces with operational department management, Health Plans and State representatives on fraud and abuse issues. Ensures continuing development of effective professional relationships with the Legal, Medical Management, Claims and Cost Containment Departments.

5. Assists in the development of departmental policies and procedures regarding documentation and coding standards. Develops appropriate process and case documentation to support the mission of the Corporate Investigations Department. 6. Establishes and maintains working relationships with all internal departments and senior management in the plan(s) to which they are assigned including CEO’s, Chief Compliance Officers, medical Directors, Provider Relations, Claims, etc.

7. Analyzes data as part of the investigative process using available resources.

8. Prepares and submits findings and makes recommendations to senior management.

9. Participates in identifying new initiatives and/or projects that will identify and reduce fraud and abuse, to include pre and post payment.

10. Assists in the evaluation and implementation of strategies to flag and evaluation claims of certain providers who are billing out of normal ranges, to include training the providers.

11. Assists in the evaluation, design and implementation of strategies to send communications to providers who are billing out of normal ranges, to include training the providers and monitoring impact on future billing patterns.

12. Develops, maintains and recommends current departmental coding resources.

13. Performs other duties as assigned or requested.

Qualifications:

EDUCATION REQUIREMENTS

Education

Bachelor’s degree in related field such as Nursing, Healthcare Management, or Health Information Systems. Equivalent work experience accepted in lieu of education.

Years and Type of Experience Required:

Required:
- Minimum 5 years claim coding experience with two years medical claims review and/or auditing experience.

Preferred:
- Minimum 5 years claim coding experience with two years medical claims review and/or auditing experience and minimum of two years of health care fraud audit/investigation experience in managed care setting is strongly preferred.
- Previous experience coordinating with internal legal representation.

Certifications or Licensures

Required:
- Certified Professional Coder (Requirement may vary by department).

Preferred:
- Registered Nurse or Licensed Practical Nurse (Requirement may vary by department).
- Certified Fraud Examiner (CFE).
- Accredited HealthCare Fraud Investigator (AHFI).

Language Skills

Required:
- English

Functional Competencies
- Demonstrated experience in Microsoft office products: Word, Excel and Power Point.
- Understanding of CMS 1500 and UB04 billing claim forms.
- Coding experience (ICD-9, CPT-4, E&M and HCPCS).
- Demonstrated experience with data mining, analysis, reporting and business intelligence techniques.
- Experience with healthcare claims systems (Facets and/or AMISYS).
- Experience with desktop coding platforms.
- Ability to provide testimony in civil or criminal hearings.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed (approximately 10%) and adhere to AMERIGROUP travel policies and procedures.

ermHO
]]>Sat, 27 Apr 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Norfolk-Clinical-Auditor-Reimbursement-Job-VA-23501/2455579/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Norfolk-Clinical-Auditor-Reimbursement-Job-VA-23501/2455579/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-21689 # Positions 1
Location US-KS-Overland Park
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/1/2013
Additional Locations ..

More information about this job:
Summary:

Serves as liaison to providers and is responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers. These activities include responding to inquiries from providers to clarify issues related to member benefits, claim resolution, appeal status, provider recruitment, and authorization or referral information. May perform position requirements in the field or telephonically, as appropriate.

Responsibilities:

1. Responds to telephonic and written inquiries from providers.

2. Ensures that provider relationships with the Plan are positive and productive for both parties.

3. Participates in problem solving with providers. Identifies and monitors provider issues and concerns, recommends solutions, and works with local and corporate staff to resolve the issues.

4. Collaborates with local and corporate staff as necessary to ensure that appropriate contracts are executed and implemented and that all providers are credentialed in a timely manner.

5. Analyzes provider network for adequacy in addressing members’ medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist.

6. Creates and maintains information required to support the network development process.

7. Conducts onsite provider education forums, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.

8. Provides expertise and assistance with guidelines relative to provider billing and payment.

9. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled.

10. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.

11. Participates in earnings improvement opportunities, as appropriate and achieving strategic objectives relating to the Provider network.

12. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Preferred:
- BA/BS degree preferred or equivalent experience.

Years and Type of Experience Required:

Preferred:
- 3-5 years of managed care experience, preferably in a Medicaid environment.

Specific Technical Skills

Required:
- Experience with computer software applications including Excel.
- Claims experience/knowledge of medical coding.

Other:

Required:
- Excellent verbal and written communication skills.
- Detail-oriented.
- Ability to handle multiple tasks.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer, telephone and fax machine.

CB2

ermCS
]]>Fri, 17 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-Provider-Relations-Rep-I-Job-KS-66062/2373325/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-Provider-Relations-Rep-I-Job-KS-66062/2373325/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22578 # Positions 1
Location US-TX-Houston
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

Serves as liaison to providers and is responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers. These activities include responding to inquiries from providers to clarify issues related to member benefits, claim resolution, appeal status, provider recruitment, and authorization or referral information. May perform position requirements in the field or telephonically, as appropriate. Successful candidates must currently resided in or be willing to relocate to the Houston area.

Responsibilities:

1. Responds to telephonic and written inquiries from providers.

2. Ensures that provider relationships with the Plan are positive and productive for both parties.

3. Participates in problem solving with providers. Identifies and monitors provider issues and concerns, recommends solutions, and works with local and corporate staff to resolve the issues.

4. Collaborates with local and corporate staff as necessary to ensure that appropriate contracts are executed and implemented and that all providers are credentialed in a timely manner.

5. Analyzes provider network for adequacy in addressing members’ medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist.

6. Creates and maintains information required to support the network development process.

7. Conducts onsite provider education forums, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.

8. Provides expertise and assistance with guidelines relative to provider billing and payment.

9. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled.

10. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.

11. Participates in earnings improvement opportunities, as appropriate and achieving strategic objectives relating to the Provider network.

12. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Preferred:
- BA/BS degree preferred or equivalent experience.

Years and Type of Experience Required:

Preferred:
- 3-5 years of managed care experience, preferably in a Medicaid environment.
- Bilingual Spanish/English

Specific Technical Skills

Required:
- Experience with computer software applications including Excel.
- Claims experience/knowledge of medical coding.

Other:

Required:
- Excellent verbal and written communication skills.
- Detail-oriented.
- Ability to handle multiple tasks.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer, telephone and fax machine.

ermCS
]]>Tue, 14 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Provider-Relations-Rep-I-Job-TX-77001/2546973/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Provider-Relations-Rep-I-Job-TX-77001/2546973/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22597 # Positions 4
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/16/2013
Additional Locations ..

More information about this job:
Summary:

Under minimal supervision, the Recovery Specialist II is responsible for reviewing claims data to identify, confirm and execute the recovery of identified overpayments. Performs all authorized duties in the processing of overpayments allocated to the assigned market consistent with all applicable company and departmental policies.

Responsibilities:

1. Researches claims data to identify potential overpayments to providers through independent work and/or with other departments or work groups.

2. Maintains working knowledge of all company products and services pertaining to business segment.

3. Prepares and submits productivity and savings reports.

4. Meets or exceeds established productivity and quality.

5. Prepares and sends correspondence to Providers notifying of claims overpayment(s).

6. Work with health plans regarding overpayment Provider disputes.

7. Communicates with Providers regarding overpayment disputes, on occasion.

8. Adheres to company and department policies and procedures, as well as state and federal regulations.

9. Performs other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High school diploma or GED.

Preferred:
- Associate’s degree or Medical coding coursework.

Years and Type of Experience Required:

Required:
- Four years medical claims processing or medical billing or collections experience, or demonstrated proficiency as an Recovery Specialist I.

Language Skills

Required:
- English

TECHNICAL COMPETENCIES

Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain simple tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard, 10 key and typing at 35 words/minute.
- Use of internet and some familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use spreadsheets to open, review, edit and save data.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells).

Read, Interpret and Apply Information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process adjustments.
- Capacity to follow step-by-step directions, remain detail oriented and verify data from EOB's including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contract terms as related to payment policies for outpatient and inpatient claims.

Medical, Recovery & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Knowledge of other healthcare companies and third party insurance.
- Some understanding of Cost Containment/Overpayment processes, such as COB.
- Familiarity with claims medical coding.
- Working knowledge of recovery practices.

System Familiarity
- Ability to use a claims adjudication system to process claims, such as Facets.
- Familiarity with image repository-review systems for the retrieval of documents.
- Ability to identify system issues to management for problem solving

COMMUNICATION SKILLS:

Verbal, Written and Telephonic
- Ability to use proper language, grammar and style in the preparation of verbal and written messages to clearly, effectively and professionally convey an appropriate message.
- Skills to properly handle telephone inquiry with customers (providers, vendors and other health insurance carriers).

BEHAVIORAL COMPETENCIES

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.

ermCS
]]>Wed, 15 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Recovery-Specialist-II-Job-VA-23450/2549311/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Recovery-Specialist-II-Job-VA-23450/2549311/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22484 # Positions 1
Location US-NV-Las Vegas
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/26/2013
Additional Locations ..

More information about this job:
Summary:

Serves as liaison to providers (including physicians, hospitals, and/or ancillary providers) and internal departments at the health plan. Responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers for Medicaid and Medicare products. These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information. Also may be responsible for recruiting providers to ensure network access and service adequacy. Provides training, guidance and assistance to Provider Relations Representatives I to support their skill development and successful completion of assignments. May perform position requirements in the field or telephonically, as appropriate. More emphasis is placed on field work at the rep level II.

Responsibilities:

1. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force).

2. Ensures that provider relationships with the Plan are positive and productive for both parties.

3. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. Works with Provider’s staff and AMERIGROUP staff (local and/or corporate) to resolve the issue and monitor recurrence.

4. Assists with training and mentoring of the Provider Relations Representatives as needed to ensure departmental success and effective team work. In the absence of management, acts as the lead or senior associate in the department or for the assigned team.

5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner.

6. Analyzes provider network for adequacy in addressing members’ medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist.

7. Creates and maintains information required to support the network development process.

8. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.

Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures.

9. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames.

10. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.

11. Performs other duties and special projects as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- BA/BS degree or equivalent experience.

Years and Type of Experience Required:

Required:
- 5+ years of managed care experience, preferably in a Medicaid environment.

Specific Technical Skills

Required:
- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Claims experience/knowledge of medical coding
- Strong telephonic and customer service skills.
- Effective presentation skills.

Preferred:
- Experience using Sales force CRM.
- Experience using Facets.

Certifications or Licensures

Required:
- Valid Driver’s License

Other:

Required:
- Excellent verbal and written communication skills.
- Detail-oriented.
- Ability to handle multiple tasks in a fast-paced environment.
- Must be service oriented and able to identify and resolve problems.
- Appreciation of cultural diversity and sensitivity toward target population.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer, telephone and fax machine.
- Must be able to travel locally.
- Must be able to operate a motor vehicle.
- Must be able to conduct and participate in meetings.

ermCS
]]>Fri, 26 Apr 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Las-Vegas-Provider-Relations-Rep-II-Job-NV-89044/2569050/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Las-Vegas-Provider-Relations-Rep-II-Job-NV-89044/2569050/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22723 # Positions 1
Location US-LA-Shreveport
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/1/2013
Additional Locations ..

More information about this job:
Summary:

Serves as liaison to providers (including physicians, hospitals, and/or ancillary providers) and internal departments at the health plan. Responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers for Medicaid and Medicare products. These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information. Also may be responsible for recruiting providers to ensure network access and service adequacy. Provides training, guidance and assistance to Provider Relations Representatives I to support their skill development and successful completion of assignments. May perform position requirements in the field or telephonically, as appropriate. More emphasis is placed on field work at the rep level II.

Responsibilities:

1. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force).

2. Ensures that provider relationships with the Plan are positive and productive for both parties.

3. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. Works with Provider’s staff and AMERIGROUP staff (local and/or corporate) to resolve the issue and monitor recurrence.

4. Assists with training and mentoring of the Provider Relations Representatives as needed to ensure departmental success and effective team work. In the absence of management, acts as the lead or senior associate in the department or for the assigned team.

5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner.

6. Analyzes provider network for adequacy in addressing members’ medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist.

7. Creates and maintains information required to support the network development process.

8. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.

Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures.

9. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames.

10. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.

11. Performs other duties and special projects as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- BA/BS degree or equivalent experience.

Years and Type of Experience Required:

Required:
- 5+ years of managed care experience, preferably in a Medicaid environment.

Specific Technical Skills

Required:
- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Claims experience/knowledge of medical coding
- Strong telephonic and customer service skills.
- Effective presentation skills.

Preferred:
- Experience using Sales force CRM.
- Experience using Facets.

Certifications or Licensures

Required:
- Valid Driver’s License

Other:

Required:
- Excellent verbal and written communication skills.
- Detail-oriented.
- Ability to handle multiple tasks in a fast-paced environment.
- Must be service oriented and able to identify and resolve problems.
- Appreciation of cultural diversity and sensitivity toward target population.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer, telephone and fax machine.
- Must be able to travel locally.
- Must be able to operate a motor vehicle.
- Must be able to conduct and participate in meetings.

ermCS
]]>Wed, 01 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Shreveport-Provider-Relations-Rep-II-Job-LA-71101/2576448/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Shreveport-Provider-Relations-Rep-II-Job-LA-71101/2576448/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22805 # Positions 1
Location US-TX-San Antonio
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/14/2013
Additional Locations ..

More information about this job:
Summary:

The incumbent is responsible coordinating the resolution of claims issues by actively researching and analyzing systems and processes that span across multiple operational areas.

This position may be located in San Antonio, Lubbock, El Paso, Houston, or the Dallas/Fort Worth area.

Responsibilities:

1. Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.

2. Identifies the interdependencies of the resolution of claims errors on other activities within operations.

3. Assists in the reviews of state or federal complaints related to claims. Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines.

4. Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved.

5. Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues.

6. Recommends new or modified processes and procedures to reduce claims errors, taking into consideration business requirements and system limitations.

7. Performs user acceptance testing to ensure new contracts are loaded correctly and system modifications are accurate.

8. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree, or equivalent related experience

Years and Type of Experience Required:

Required:
- Five years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key.
- Use of internet, familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells).
- Ability to work in databases.

Office Math Skills
- Ability to process numbers, which is an essential skill for any problem solving situation in a claims environment.
- Skills in the use of a calculator (using percentages, multiplication and division) to determine appropriate benefit payment.
- Ability to calculate the manual pricing of claims.
- Skills to verify accuracy with visual percentage calculations.

Read, Interpret and Apply Information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process claims.
- Capacity to follow step-by-step and general directions, remain detail oriented and verify data including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contracts for outpatient and inpatient claims.
- Ability to prepare written communication to providers documenting the results of their inquiry.
- Ability to convey results of inquiry through written communication (letter, fax, e-mail) or verbal communication (telephone).

Medical & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Working knowledge of Medicaid and Medicare benefits.
- Familiarity with claims medical coding.
- Knowledge of the different standard claims forms used for physician and hospital billing.
- Understand COB and LTC processes.
- Knowledge of state and/or federal guidelines that apply to the Medicaid or Medicare benefits.
- Understand the different levels of care and applicable payment methodology.

Claims System Familiarity
- Understanding of the claims payment system.
- Ability to access documentation through the use of an image repository-review system, such as Macess.
- Ability to apply multiple market information and process high dollar claims due to authorization level
- High level understanding of system configuration for benefits, pricing, and provider set up.
- Ability to identify system issues to management for problem solving.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermCS
]]>Tue, 14 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/San-Antonio-Claims-Resolution-Analyst-Job-TX-78201/2597172/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/San-Antonio-Claims-Resolution-Analyst-Job-TX-78201/2597172/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22935 # Positions 1
Location US-WA-Seattle
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

The incumbent is responsible coordinating the resolution of claims issues by actively researching and analyzing systems and processes that span across multiple operational areas.

Responsibilities:

1. Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing.

2. Identifies the interdependencies of the resolution of claims errors on other activities within operations.

3. Assists in the reviews of state or federal complaints related to claims. Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines.

4. Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved.

5. Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues.

6. Recommends new or modified processes and procedures to reduce claims errors, taking into consideration business requirements and system limitations.

7. Performs user acceptance testing to ensure new contracts are loaded correctly and system modifications are accurate.

8. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree, or equivalent related experience

Years and Type of Experience Required:

Required:
- Five years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key.
- Use of internet, familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells).
- Ability to work in databases.

Office Math Skills
- Ability to process numbers, which is an essential skill for any problem solving situation in a claims environment.
- Skills in the use of a calculator (using percentages, multiplication and division) to determine appropriate benefit payment.
- Ability to calculate the manual pricing of claims.
- Skills to verify accuracy with visual percentage calculations.

Read, Interpret and Apply Information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process claims.
- Capacity to follow step-by-step and general directions, remain detail oriented and verify data including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contracts for outpatient and inpatient claims.
- Ability to prepare written communication to providers documenting the results of their inquiry.
- Ability to convey results of inquiry through written communication (letter, fax, e-mail) or verbal communication (telephone).

Medical & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Working knowledge of Medicaid and Medicare benefits.
- Familiarity with claims medical coding.
- Knowledge of the different standard claims forms used for physician and hospital billing.
- Understand COB and LTC processes.
- Knowledge of state and/or federal guidelines that apply to the Medicaid or Medicare benefits.
- Understand the different levels of care and applicable payment methodology.

Claims System Familiarity
- Understanding of the claims payment system.
- Ability to access documentation through the use of an image repository-review system, such as Macess.
- Ability to apply multiple market information and process high dollar claims due to authorization level
- High level understanding of system configuration for benefits, pricing, and provider set up.
- Ability to identify system issues to management for problem solving.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermCS
]]>Wed, 22 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Seattle-Claims-Resolution-Analyst-Job-WA-98101/2611287/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Seattle-Claims-Resolution-Analyst-Job-WA-98101/2611287/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22674 # Positions 1
Location US-TX-Houston
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/24/2013
Additional Locations ..

More information about this job:
Summary:

Provides leadership and day-to-day direction for production-related claims activities across all markets within the claims department, to include: claims processing and payment, management reporting and management and development of staff. Develops and implements policies, procedures and processes that ensure the timely payment of claims in accordance with contractual, State and Federal requirements.

Responsibilities:

1. Evaluates and manages all daily activities and issues involving the accurate and timely processing of claims within state and federal requirements and performance guarantees for assigned markets/products. Sets goals to meet and exceed customer expectations.

2. Manages the day-to-day activities of assigned associates, supervises staff creating development plans for associates, providing timely and effective feedback, and develops corrective action plans when needed.

3. Develops strong relationships with internal/external partners, practicing excellent customer relations and attention to customer needs.

4. Ensures the preparation and analysis of all standard claim reports as requested (i.e. aging, contact logs, quality reports and action grams, etc).

5. Monitors claims processing activities to ensure that the organization’s service, quality, productivity and financial standards or goals are achieved.

6. Develops policies, procedures and processes to ensure the successful implementation of new or revised contracts in accordance with Federal, State and other regulatory agency requirements.

7. Serves as the department expert for the Health Plan in the areas of provider billing, provider reimbursement and benefits. Interprets contract language and rates and coordinates with other internal customers to ensure the accuracy of system configuration and claims processing.

8. Reviews and responds to all regulatory updates and ensures all statistical performance reports are generated within the required time frames.

9. Initiates and leads communication with claims teams and other functional areas to ensure resolution to issues and provide long-term solutions.

10. Assists with meeting budget and understanding capacity model/management for assigned markets to effectively and appropriately staff for claim volume.

11. Adheres to and manages to ensure the adherence to all Amerigroup and department policies and procedures, as well as HIPAA regulations.

12. Develops and implements process improvements with high impact to increase/improve productivity and quality results within the department.

13. Performs other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in related field or equivalent experience.

Years and Type of Experience Required:

Required:
- Five years of experience in health care claims administration or in a health care insurance company management capacity with at least one year of leadership/supervisory experience.

Internal candidates:
- Demonstrated proficiency and two years experience as a Supervisor/Manager within the company.
- Successful completion of Amerigroup Leadership Development Program in lieu of above years of experience.

Preferred:
- Claims processing experience.

Language Skills

Required:
- English

Technical Competencies Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key.
- Use of internet, familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells). - Ability to work in databases.

Office Math Skills
- Ability to process numbers, which is an essential skill for any problem solving situation in a claims environment.
- Skills in the use of a calculator (using percentages, multiplication and division) to determine appropriate benefit payment.
- Ability to calculate the manual pricing of claims. Skills to verify accuracy with visual percentage calculations. Read, Interpret and Apply information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process claims.
- Capacity to follow step-by-step and general directions, remain detail oriented and verify data including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contracts for outpatient and inpatient claims.
- Ability to prepare written communication to providers documenting the results of their inquiry.
- Ability to convey results of inquiry through written communication (letter, fax, e-mail) or verbal communication (telephone).

Medical & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Working knowledge of Medicaid and Medicare benefits.
- Familiarity with claims medical coding.
- Knowledge of the different standard claims forms used for physician and hospital billing.
- Understand COB and LTC processes.
- Knowledge of state and/or federal guidelines that apply to the Medicaid or Medicare benefits.
- Understand the different levels of care and applicable payment methodology.

Claims System Familiarity
- Understanding of the claims payment system.
- Ability to access documentation through the use of an image repository-review system, such as Macess.
- Ability to apply multiple market information and process high dollar claims due to authorization level.
- High level understanding of system configuration for benefits, pricing, and provider set up.
- Ability to identify system issues to management for problem solving.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Sees the "big picture" (e.g., overall themes, trends, goals).
- Integrates and balances big-picture concerns with day-to-day activities.
- Establishes strategies for achieving individual or work unit goals.

Make Sound Decisions
- Analyzes, incorporates and applies new information and concepts.
- Recognizes symptoms that indicate problems.
- Makes sound decisions on everyday issues and problems.
- Makes timely decisions on problems/issues requiring immediate attention.

People Leadership Develop/Support Organizational Talent
- Identifies and recruits/refers qualified people.
- Makes accurate evaluations of people's capabilities and fit.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Ensure Collaboration
- Provides sound rationale for recommendations.
- Solicits support for ideas.
- Ensures that own positions address others' needs and priorities.
- Builds relationships to create a foundation for future influence.

Results Leadership Show Drive and Initiative
- Identifies what needs to be done and does it.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Conveys clear expectations for assignments.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Seeks additional resources to complete tasks when needed.

SCOPE INFORMATION

# Direct Reports: 15-25

# Indirect Reports: 0

Budgetary $ Responsibility: N/A

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.

ermCS
]]>Thu, 23 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Mgr-Claims-Job-TX-77001/2564571/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Mgr-Claims-Job-TX-77001/2564571/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22619 # Positions 40
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/18/2013
Additional Locations ..

More information about this job:
Summary:

Associates are focused on understanding and meeting the needs of our customers by connecting with the mission and vision in their daily work activity. Claims associates are not only processors, but are challenged to use their analytical skills to identify issues and proactively engage to solve problems that may negatively impact our customers. While anticipating the needs of our customers, Claims associates will be skilled in the uniqueness of their markets to insure that every claim is handled appropriately and accurately, with the goal of “treating each claim as a member”. While meeting production goals is important and necessary, at Amerigroup, Claims associates will connect their work with the impact on our customers to create an amazing customer experience.

If you are looking for a way to make a difference in the lives of others by offering a little help to those in need, you are invited to further explore employment opportunities at Amerigroup.

Under general supervision, analysts evaluate simple to moderately complex claims to determine the type and amounts of benefits payable. You will perform all authorized duties in the processing of claims allocated to the assigned market consistent with all applicable company and departmental policies.

This requisition is posted for candidates interested in a traning class in Virginia Beach during the 2nd quarter of 2013.

Responsibilities:

1. Researches and processes all intermediate level claims transactions. Processing includes most claim types with the exception of inpatient, transplant, dialysis and hospice.

2. Processes correspondence and customer service inquiries as it relates to the above claims transactions.

3. Processes primary care encounter information and fee for service claims received in both paper and automated formats into claims systems.

4. Accurately interprets, understands and applies product contracts and fee schedules for assigned markets when processing claims.

5. Interprets and applies explanation of benefits (EOB) statements from other carrier to faciliatate coordination of coverage.

6. Meets or exceeds established quality and production standards.

7. Reviews and responds to quality audits.

8. Responds timely to quality error assignments and provide appropriate documentation to support actions.

9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High school diploma or GED.

Preferred:
- Associate’s degree in business or health care field.
- Claims processing/coding certificate program.

Years and Type of Experience Required:

Required:
- One year experience in production or office environment.

Preferred:
- Two years of claims processing experience.

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key.
- Use of internet, familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells).

Office Math Skills
- Ability to process numbers, which is an essential skill for any problem solving situation in a claims environment.
- Skills in the use of a calculator (using percentages, multiplication and division) to determine appropriate benefit payment.
- Ability to calculate the manual pricing of claims. Skills to verify accuracy with visual percentage calculations.

Read, Interpret and Apply Information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process claims.
- Capacity to follow step-by-step and general directions, remain detail oriented and verify data including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contracts for outpatient and inpatient claims.

Medical & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Working knowledge of Medicaid and Medicare benefits.
- Familiarity with claims medical coding.
- Knowledge of the different standard claims forms used for physician and hospital billing.
- Understand Coordination of Benefits (COB) and Long term care (LTC) processes.
- Knowledge of state and/or federal guidelines that apply to the Medicaid or Medicare benefits.

Claims System Familiarity
- Ability to use a claims adjudication system to process claims, such as Facets.
- Ability to access documentation through the use of an image repository-review system, such as Macess.
- Ability to apply multiple market information to correctly process claims.
- Ability to identify system issues to management for problem solving.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermCS
]]>Sat, 18 May 2013 05:31:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Claims-Analyst-Job-VA-23450/2556791/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Claims-Analyst-Job-VA-23450/2556791/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22899 # Positions 40
Location US-TX-Houston
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

Associates are focused on understanding and meeting the needs of our customers by connecting with the mission and vision in their daily work activity. Claims associates are not only processors, but are challenged to use their analytical skills to identify issues and proactively engage to solve problems that may negatively impact our customers. While anticipating the needs of our customers, Claims associates will be skilled in the uniqueness of their markets to insure that every claim is handled appropriately and accurately, with the goal of “treating each claim as a member”. While meeting production goals is important and necessary, at Amerigroup, Claims associates will connect their work with the impact on our customers to create an amazing customer experience.

If you are looking for a way to make a difference in the lives of others by offering a little help to those in need, you are invited to further explore employment opportunities at Amerigroup.

Under general supervision, analysts evaluate simple to moderately complex claims to determine the type and amounts of benefits payable. You will perform all authorized duties in the processing of claims allocated to the assigned market consistent with all applicable company and departmental policies.

This requisition is posted for candidates interested in a training class to start Summer 2013 in Houston.

Responsibilities:

1. Researches and processes all intermediate level claims transactions. Processing includes most claim types with the exception of inpatient, transplant, dialysis and hospice.

2. Processes correspondence and customer service inquiries as it relates to the above claims transactions.

3. Processes primary care encounter information and fee for service claims received in both paper and automated formats into claims systems.

4. Accurately interprets, understands and applies product contracts and fee schedules for assigned markets when processing claims.

5. Interprets and applies explanation of benefits (EOB) statements from other carrier to faciliatate coordination of coverage.

6. Meets or exceeds established quality and production standards.

7. Reviews and responds to quality audits.

8. Responds timely to quality error assignments and provide appropriate documentation to support actions.

9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High school diploma or GED.

Preferred:
- Associate’s degree in business or health care field.
- Claims processing/coding certificate program.

Years and Type of Experience Required:

Required:
- One year experience in production or office environment.

Preferred:
- Two years of claims processing experience.

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key.
- Use of internet, familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells).

Office Math Skills
- Ability to process numbers, which is an essential skill for any problem solving situation in a claims environment.
- Skills in the use of a calculator (using percentages, multiplication and division) to determine appropriate benefit payment.
- Ability to calculate the manual pricing of claims. Skills to verify accuracy with visual percentage calculations.

Read, Interpret and Apply Information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process claims.
- Capacity to follow step-by-step and general directions, remain detail oriented and verify data including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contracts for outpatient and inpatient claims.

Medical & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Working knowledge of Medicaid and Medicare benefits.
- Familiarity with claims medical coding.
- Knowledge of the different standard claims forms used for physician and hospital billing.
- Understand Coordination of Benefits (COB) and Long term care (LTC) processes.
- Knowledge of state and/or federal guidelines that apply to the Medicaid or Medicare benefits.

Claims System Familiarity
- Ability to use a claims adjudication system to process claims, such as Facets.
- Ability to access documentation through the use of an image repository-review system, such as Macess.
- Ability to apply multiple market information to correctly process claims.
- Ability to identify system issues to management for problem solving.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermCS
]]>Fri, 17 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Claims-Analyst-Job-TX-77001/2604267/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Claims-Analyst-Job-TX-77001/2604267/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22659 # Positions 1
Location US-VA-Chesapeake
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 4/23/2013
Additional Locations ..

More information about this job:
Summary:

This is a senior technical position. Performs complex configuration activities. The incumbent for this position possesses a high degree of expertise in the configuration of business rules that support reimbursement policies and methodologies in a large managed care organization. This position plays a key role in the configuration and implementation of new markets and products.

Responsibilities:

1. Works with Lead Configuration Analysts to define and prioritize projects.

2. Considers interdepartmental impact when recommending solutions and identifies opportunities for interdepartmental utilization of recommended solutions.

3. Works with peers in department to develop realistic project scope estimates, detailed project plans, and timelines.

4. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements.

5. Configures, tests and documents configuration solutions for the following functions:
- Provider reimbursement configuration set-up and maintenance.
- Benefit package configuration setup and maintenance.
- Membership/divisions configuration set-up and maintenance.
- Group/member premium configuration set-up and maintenance.
- Medical management configuration set-up and maintenance.
- Employer and state group/billing configuration setup and maintenance.
- Setup and maintenance of financial management risk pools in relation to healthcare software.
- Setup of code sets used for configuration in benefits & pricing and other sub-systems.

6. Exercises good judgment in the use of configuration standards. Can propose business beneficial changes to coding standards and development procedures.

7. Adheres to existing configuration management procedures. Recommends improvements to existing procedures. Assesses work of team members to ensure compliance with procedures.

8. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs.

9. Performs complex data modeling and database design with minimal oversight.

10. Adheres to departmental and corporate policies and procedures.

11. Attends improvement training programs when available and offered.

12. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in business administration, information science, computer science, industrial engineering or a relevant area, or equivalent technical skills and experience.

Years and Type of Experience Required:

Required:
- A minimum of five years of configuration experience providing pricing and/or benefits configuration support on Amisys, Facets, MHS, Metavance, Diamond, or a similar payer system, preferably in a medium to large health care or related organization.
- Possess problem solving and project management skills. Must be able to take charge, manage numerous projects and successfully coordinate projects with internal areas and external vendors.
- Project team member oversight management and/or supervisory experience required.

Preferred:
- Experience using a software development life-cycle methodology like the Software Development Life Cycle (SDLC).
- Broad operational managed care background.

Specific Technical Skills

Required:
- A minimum of two years of experience:
- Using MS Office.
- Using the Windows operating system and its utilities.
- Using the internet to conduct research and to download information.
- Using a relational database management system or SQL to retrieve and analyze data.
- Familiarity with data structures and data types.

Preferred:
- Formal coursework using a 3-GL or a 4-GL programming language (e.g., C+, Visual Basic).

Other:

Required:
- Ability to work with integrated data using a relational database management system or SQL.
- Excellent analytical and organization skills.
- Excellent verbal and written communication skills.
- Excellent interpersonal skills, including the ability to work with all levels of personnel.

PHYSICAL REQUIREMENTS
- Must be able to participate in meetings.
- Must be able to operate a PC for extended periods of time.
- Must be able to operate and effectively utilize office telephone equipment.

ermIT
]]>Wed, 22 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Chesapeake-Sr-Configuration-Analyst-Benefits-Job-VA-23320/2561983/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Chesapeake-Sr-Configuration-Analyst-Benefits-Job-VA-23320/2561983/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22913 # Positions 1
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/20/2013
Additional Locations ..

More information about this job:
Summary:

This is a senior technical position. Performs complex configuration activities. The incumbent for this position possesses a high degree of expertise in the configuration of business rules that support reimbursement policies and methodologies in a large managed care organization. This position plays a key role in the configuration and implementation of new markets and products.

Responsibilities:

1. Works with Lead Configuration Analysts to define and prioritize projects.

2. Considers interdepartmental impact when recommending solutions and identifies opportunities for interdepartmental utilization of recommended solutions.

3. Works with peers in department to develop realistic project scope estimates, detailed project plans, and timelines.

4. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements.

5. Configures, tests and documents configuration solutions for the following functions:
- Provider reimbursement configuration set-up and maintenance.
- Benefit package configuration setup and maintenance.
- Membership/divisions configuration set-up and maintenance.
- Group/member premium configuration set-up and maintenance.
- Medical management configuration set-up and maintenance.
- Employer and state group/billing configuration setup and maintenance.
- Setup and maintenance of financial management risk pools in relation to healthcare software.
- Setup of code sets used for configuration in benefits & pricing and other sub-systems.

6. Exercises good judgment in the use of configuration standards. Can propose business beneficial changes to coding standards and development procedures.

7. Adheres to existing configuration management procedures. Recommends improvements to existing procedures. Assesses work of team members to ensure compliance with procedures.

8. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs.

9. Performs complex data modeling and database design with minimal oversight.

10. Adheres to departmental and corporate policies and procedures.

11. Attends improvement training programs when available and offered.

12. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in business administration, information science, computer science, industrial engineering or a relevant area, or equivalent technical skills and experience.

Years and Type of Experience Required:

Required:
- A minimum of five years of configuration experience providing pricing and/or benefits configuration support on Amisys, Facets, MHS, Metavance, Diamond, or a similar payer system, preferably in a medium to large health care or related organization.
- Possess problem solving and project management skills. Must be able to take charge, manage numerous projects and successfully coordinate projects with internal areas and external vendors.
- Project team member oversight management and/or supervisory experience required.

Preferred:
- Experience using a software development life-cycle methodology like the Software Development Life Cycle (SDLC).
- Broad operational managed care background.

Specific Technical Skills

Required:
- A minimum of two years of experience:
- Using MS Office.
- Using the Windows operating system and its utilities.
- Using the internet to conduct research and to download information.
- Using a relational database management system or SQL to retrieve and analyze data.
- Familiarity with data structures and data types.

Preferred:
- Formal coursework using a 3-GL or a 4-GL programming language (e.g., C+, Visual Basic).

Other:

Required:
- Ability to work with integrated data using a relational database management system or SQL.
- Excellent analytical and organization skills.
- Excellent verbal and written communication skills.
- Excellent interpersonal skills, including the ability to work with all levels of personnel.

PHYSICAL REQUIREMENTS
- Must be able to participate in meetings.
- Must be able to operate a PC for extended periods of time.
- Must be able to operate and effectively utilize office telephone equipment.

ermIT
]]>Mon, 20 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Sr-Configuration-Analyst-Telecommuters-Accepted-Job/2606768/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Sr-Configuration-Analyst-Telecommuters-Accepted-Job/2606768/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS