http://www.amerigroup-jobs.com/feeds/Recruiter-Virginia-jobs/ Custom RSS Feed for Recruiter-Virginia-jobs Thu, 23 May 2013 21:15:45 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/feeds/Recruiter-Virginia-jobs/ 720
Job ID 2013-22540 # Positions 1
Location US-VA-Virginia Beach
Search Category Human Resources
Type Regular Full-Time (30+ hours) Posted Date 4/10/2013
Additional Locations ..

More information about this job:
Summary:

Provide strategic, consultative Human Resource support and leadership for assigned business unit. Identify and frame human resource issues and solutions to business problems by providing human resource expertise in implementing the strategic business direction and in determining the essential tactical human resources elements.

Responsibilities:

1. Work closely with assigned business unit leaders to define and align HR strategy with business unit strategy. Partner with assigned client groups to gain understanding of client’s business in order to effectively support, propose and lead initiatives.

2. Act as advisor and coach on human resources issues such as associate issues and questions, managing change and supporting a positive work environment.

3. Conduct timely investigations into complaints of ADA, EEO, Workplace Harassment and other associate concerns. Provide oversight and guidance to HR generalists on sensitive associate issues.

4. Actively contribute to assembly and operation of a strong, diverse and client-focused HR team through effective recruiting, training, coaching and team building. Participate in the preparation of staff development plans. Select, develop and evaluate staff to ensure the efficient operation of the function. Provide leadership and direction to department staff as appropriate to ensure the quality of departmental work outcomes and deliverables.

5. Monitor industry and marketplace developments and trends and recommends changes and/or exceptions to established company policy and guidelines as necessary to ensure the efficient operation of the business. Work independently and in concert with other HR leaders to ensure the consistent interpretation and execution of Policy and Practices at all levels of the organization.

6. Partner with assigned business unit to support associate development and establish development plans, career paths and retention programs. Assess and make recommendations for organizational structure based on talent and organizational goals.

7. Design and implement strategies to support the business goals and culture through initiatives in diversity and leadership development including training, performance management and succession planning.

8. Actively contribute to assembly and operation of a strong, diverse and client-focused HR team through effective recruiting, training, coaching and team building. Participate in the preparation of staff development plans.

9. Lead/participate in a variety of projects and assignments including the development of personnel policies, procedures and programs.

10. Provide analysis, review and recommendations with regards to performance reviews, compensation changes/adjustments, merit increases and promotional increases for consistency and compliance with company policy and legal considerations.

11. Consult with assigned business unit leaders on the development and execution of staffing plans and job evaluations. Consult with business owners on the development and execution of departmental and business unit reorganization plans, reduction in force, and other resource re-deployment activities.

12. May plan and recommend budgets, manage expenditures, and report on budget variances.

13. May manage other areas such as Facilities, Security, Safety, Purchasing, or Training as assigned.

14. Other duties as assigned.

Qualifications:

Education

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

Preferred: Master’s degree

Years and Type of Experience Required:

Required: Minimum 7 years of related work experience with at least 3 years of leadership/management experience.

Specific Technical Skills

Required: Excellent computer skills including Microsoft Office Suite

Preferred: Experience working with PeopleSoft

Certifications or Licensures

Preferred: SPHR

Other:

Required:
- Strong Employee Relations background and knowledge to include: federal, state and local laws and regulations including but not limited to: OFCCP, DOL, NLRA, FLSA, EEO, FMLA, ERISA laws/issues, etc.
- Comprehensive knowledge and experience in all areas of HR to include employment, compensation, benefits, employee relations, HRIS and payroll administration
- Ability to assess and develop solutions for organizational development and training needs.
- Experience in budgeting and strategic planning.
- Excellent verbal and written communication skills, especially giving and receiving feedback.
- Strong organizational and analytical skills.
- Provide high level of customer service.
- Strong interpersonal skills and ability to use tact and diplomacy.
- Ability to maintain confidentiality.
- Strong presentation skills.
- Dedicated team player, who demonstrates initiative and independence.
- Proven problem solving and negotiation skills.
- Must be flexible; able to handle multiple projects and changing priorities.
- High energy and a positive can-do attitude.
- Motivates others, provides innovative ideas and solutions, and promotes the department vision for improvement.
- Previous experience in working within a highly-matrixed environment. Ability to deliver by managing through others.
- Ability to perform in a fast paced environment and make appropriate decisions quickly.
- Excellent negotiation skills and proven management skills.
- Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION
- # Direct Reports: 1-4
- # Indirect Reports:

Varies Budgetary $ Responsibility:

Varies based on assignment

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

ermCorp
]]>Thu, 09 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Director-Human-Resources-Job-VA-23450/2540206/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Director-Human-Resources-Job-VA-23450/2540206/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22608 # Positions 1
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/17/2013
Additional Locations ..

More information about this job:
Summary:

Recommends, develops, and implements quality and process improvement strategies. Responsible for planning, developing, coordinating, and implementing quality improvement initiatives stretching across business lines to various health plans and corporate units. Responsible for process mapping and process flows for the departments in which they support. Support process owners by identifying problems, finding root causes, and developing improvement strategies. Leads process and quality improvement team.

Responsibilities:

1. Develop and manage all process mapping and process flows.

2. Ensure timely completion of projects that support critical goals and requirements.

3. Work with department head and Business Unit leaders to facilitate setting priorities, developing agendas, and designing objectives for process improvement projects.

4. Develop and communicate business case to support recommendations for change to current business practices and processes, and develop controls to monitor the progress associated with the implementation of recommended changes.

5. Serve as the corporate policies and procedures department key point of contact for department policies and policy (P&P) review and maintenance and maintains inventory of current P&Ps. Develop and maintain departmental P&P update, review and maintenance processes.

6. Engage proper resources to facilitate root cause analysis and identification of process or training deficiencies.

7. Work with business leaders to coordinate improvement efforts across business lines.

8. Assist in the building and implementation of a process & quality improvement team / function.

9. Conduct effective presentations and act as a subject-matter expert / mentor on quality improvement activities.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Preferred:
- Master’s degree in business administration, statistics, or healthcare related field, or equivalent work experience.

Years and Type of Experience Required:

Required:
- 5 years relevant experience in the areas of process improvement and project management with at least 1 year of leadership/management experience.
- Successful completion of Amerigroup Leadership Development Program in lieu of above years of experience.

Preferred:
- Experience in functional operations activities.
- Experience in a HMO or managed care environment.
- Experience utilizing Six Sigma & Lean methodologies.

Certifications or Licensures

Required:
- N/A

Preferred:
- Certified PMP, Certified Green Belt,

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Intermediate
- Solid knowledge of core IT applications and systems. Proficient with all applicable company supported software applications.
- Solid understanding of Microsoft Operating Systems and Office products. Strong knowledge of personal computers and laptops. Solid knowledge of relevant hardware and software testing, change control, configuration management, test plan development and systems documentation of desktop-related equipment.
- Ability to plan, deploy and support relevant hardware and software.
- Ability to use hardware and software of a computer to complete certain moderately complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Read, Interpret and Apply Information - Intermediate
- Able to understand and diagnose complex hardware and software problems, and recommend and implement appropriate solutions.
- Able to read, comprehend and interpret complex information to provide accurate and appropriate information to associates, business partners or customers.
- Able to research information using available resources and determine where gaps in information exist to seek other sources.
- Able to understand when to escalate erroneous/inconsistent information to the appropriate level of management.
- Able to continually assess information and needs, and implement appropriate measures that will address needs and ensure customer expectations are met or exceeded.

Project Management - Intermediate
- Ability to develop, manage and implement multiple project plans with minimal direction and supervision.

Communication Skills - Intermediate
- Able to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style.
- Able to create and deliver presentations, training materials and updates to a variety of audiences. Able to effectively handle escalated issues to diffuse concerns through verbal and written messages.

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: 0

# Indirect Reports:

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.

ermCS
]]>Thu, 16 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Mgr-Ops-Process-Improvement-Job-VA-23450/2551825/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Mgr-Ops-Process-Improvement-Job-VA-23450/2551825/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22713 # Positions 1
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/30/2013
Additional Locations ..

More information about this job:
Summary:

The Mgr Ops Process Improvement is a senior-level position requiring significant experience in project management, root-cause analysis, and data analytics. The incumbent will plan, implement and develop complex business process improvements focused on call center quality assurance initiatives, utilizing flow charts, project plans, operating procedures, labor standards, reasonable expectations, process metrics, documentation, and education. Project management and extensive data analytics within a call center or quality assurance environment is required.

Responsibilities:

1. Develop and manage all process mapping and process flows.

2. Ensure timely completion of projects that support critical goals and requirements.

3. Work with department head and Business Unit leaders to facilitate setting priorities, developing agendas, and designing objectives for process improvement projects.

4. Develop and communicate business case to support recommendations for change to current business practices and processes, and develop controls to monitor the progress associated with the implementation of recommended changes.

5. Serve as the corporate policies and procedures department key point of contact for department policies and policy (P&P) review and maintenance and maintains inventory of current P&Ps. Develop and maintain departmental P&P update, review and maintenance processes.

6. Engage proper resources to facilitate root cause analysis and identification of process or training deficiencies.

7. Work with business leaders to coordinate improvement efforts across business lines.

8. Assist in the building and implementation of a process & quality improvement team / function.

9. Conduct effective presentations and act as a subject-matter expert / mentor on quality improvement activities.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Preferred:
- Master’s degree in business administration, statistics, or healthcare related field, or equivalent work experience.

Years and Type of Experience Required:

Required:
- 5 years relevant experience in the areas of process improvement and project management with at least 1 year of leadership/management experience.
- Successful completion of Amerigroup Leadership Development Program in lieu of above years of experience.

Preferred:
- Experience in functional operations activities.
- Experience in a HMO or managed care environment.
- Experience utilizing Six Sigma & Lean methodologies.

Certifications or Licensures

Required:
- N/A

Preferred:
- Certified PMP, Certified Green Belt,

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Intermediate
- Solid knowledge of core IT applications and systems. Proficient with all applicable company supported software applications.
- Solid understanding of Microsoft Operating Systems and Office products. Strong knowledge of personal computers and laptops. Solid knowledge of relevant hardware and software testing, change control, configuration management, test plan development and systems documentation of desktop-related equipment.
- Ability to plan, deploy and support relevant hardware and software.
- Ability to use hardware and software of a computer to complete certain moderately complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Read, Interpret and Apply Information - Intermediate
- Able to understand and diagnose complex hardware and software problems, and recommend and implement appropriate solutions.
- Able to read, comprehend and interpret complex information to provide accurate and appropriate information to associates, business partners or customers.
- Able to research information using available resources and determine where gaps in information exist to seek other sources.
- Able to understand when to escalate erroneous/inconsistent information to the appropriate level of management.
- Able to continually assess information and needs, and implement appropriate measures that will address needs and ensure customer expectations are met or exceeded.

Project Management - Intermediate
- Ability to develop, manage and implement multiple project plans with minimal direction and supervision.

Communication Skills - Intermediate
- Able to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style.
- Able to create and deliver presentations, training materials and updates to a variety of audiences. Able to effectively handle escalated issues to diffuse concerns through verbal and written messages.

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: 0

# Indirect Reports:

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.

ermCS
]]>Wed, 01 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Mgr-Ops-Process-Improvement-Job-VA-23450/2575520/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Mgr-Ops-Process-Improvement-Job-VA-23450/2575520/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22820 # Positions 1
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/10/2013
Additional Locations ..

More information about this job:
Summary:

Provides leadership and direction for all production-related cost containment activities across all markets to include overpayment recovery, coordination of benefits, third party liability recovery, fraud and abuse and medical claims review. Accountable for team performance measures. Manages cost containment vendor relationships. Serves as a primary contact for legal and regulatory issues regarding claims or cost containment. Possesses the business and technical expertise required to perform the critical tasks of the job.

Responsibilities:

1. Ensure recovery PMPM and overall dollar targets are met.

2. Coordinate efforts with health plans to maximize recovery efforts, yet minimize impact to provider networks.

3. Establish/maintain/improve processes to identify and recover overpaid/misplaced funds while ensuring adherence to state mandated requirements.

4. Coordinate closely with Legal and Provider Configuration to “flag” suspect providers, conduct investigations and close cases in a timely manner.

5. Coordinate with Claims teams to help identify potential recovery opportunities and to communicate any root causes of errors found in the overpayment review process.

6. Implement quality assurance program across all functions within Cost Containment.

7. Coordinate with Quality Assurance and cost containment vendors to track processing errors seen in overpayment recovery. Provide feedback to appropriate department such as Claims, Enrollment and Provider Configuration.

8. Partner with Medical Finance to ensure reported savings are accurate and validated.

9. Ensure that information provided to Cost Containment team members is consistent with information other departments, i.e., Special Processing Instructions (SPIs) from Claims, Medical Management information, etc.

10. Responsible for writing and updating policies and procedures related to cost containment activities.

11. Performs other duties as assigned.

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 operations in a managed care or financial organization with at least one year of leadership/supervisory experience.

Preferred:
- Cost containment or 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, 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 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.

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 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.
- Understanding of Cost Containment/Overpayment processes, such as COB.
- Familiarity with claims medical coding.
- Working knowledge of recovery practices.
- Understand DRG, capitation - per diem rules.
- Understand the different levels of care and applicable payment methodology.

System Familiarity
- Ability to use a claims adjudication system to process claims, such as Facets.
- Familiarity with an image repository-review system for the retrieval of documents.
- Ability to identify system issues to management for problem solving.
- Understanding of the system configuration concepts for benefits, pricing, and provider set up.

Communication Skills: Verbal, Written and Telephonic
- Ability to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style in the preparation of verbal and written messages.
- Skills to properly handle telephone inquiry with customers (providers, vendors and other health insurance carriers).
- Ability to prepare, edit and convey a variety of messages including presentations, settlement materials and updates.
- Ability to handle escalated issues through verbal and written messages.

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: 3-6

# Indirect Reports: 10-25

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.

ermCS
]]>Fri, 10 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Mgr-Cost-Containment-Job-VA-23450/2592121/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Mgr-Cost-Containment-Job-VA-23450/2592121/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22830 # Positions 1
Location US-VA-Richmond
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/13/2013
Additional Locations ..

More information about this job:
Summary:

The incumbent will assist the Health Plan CEO in the fiscal and or operational management of the Health Plan. Responsibilities include serving as the liaison to all Virginia Beach support services and regulators, local network development, provider partnerships, provider relations, medical, case and quality management programs, performance management/improvement, budgets, complaints and appeals, regulatory and contractual compliance, monthly financials, and reporting. Provide input on overall strategic direction especially strategies affected by service delivery matters, operations, practices and policies.

Responsibilities:

1. Establish overall standards, policies and objectives for all Health Plans in accordance with applicable regulatory requirement; ensure alignment and support with overall mission, goals and objectives.

2. Act as a liaison to regulators for operational matters and to home office personnel by working cooperatively to ensure development and nurturing of a collaborative work environment to facilitate involvement in planning and operations as appropriate.

3. Serves as the liaison to all support services, Claims, Enrollment, MPS, Finance, Business Control, Med/Finance, Regulatory Compliance, IT, etc., in Virginia Beach. Participates in cross-company operational activities on an ad hoc (e.g., Service Center Audits) and ongoing (e.g., MOR; QOR) basis.

4. For the first six months, the accountability for the oversight of all health plan medical management programs will be managed by Health Plan CEO including: concurrent review, pre-certification, discharge planning, case management, disease management, provider profiling, quality management, accreditation, health promotion and outreach. Facilitates and collaborates with NCC medical management staff to identify gaps and improve processes. Oversight will be re-evaluated after six months.

5. Accountable for the oversight of the design and development of provider contracts and partnerships to achieve quality, cost management, and strategic business development objectives; develops and negotiates strategic provider contracts on behalf of the Plan.

6. May be accountable for other areas of Plan operations including, but not limited to, marketing, operations, and specific products such as long term care.

7. Leads and manages the Plans performance management/earnings improvement activities. Assists in developing policy and programs to achieve business results through effective financial management.

8. Assists CEO with development and management of the Plan’s annual administrative, medical and capital budget process, monthly reporting and review of financials/accruals.

9. Coach and develop team members; adhere to the Company’s recruitment, selection, termination, and performance management processes. Act as advisor to subordinate managers or staff to help meet established schedules.

10. The CEO will manage the Plan’s complaint, appeals, pended claims, and claims research functions for the first six months and then be re-evaluated.

11. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in relevant field of work or equivalent experience in Business, Healthcare Administration or related field.

Preferred:
- Master’s degree.

Years and Type of Experience Required:

Required:
- At least 14 years of relevant experience including ten years of in-depth experience in the HMO/healthcare field.
- At least 10 years of leadership/management experience.

Language Skills

Required:
- English

Functional Competencies
- Comprehensive knowledge of managed care delivery systems and how they can work to improve quality of care and reduce costs.
- Strong financial management skills.
- Proven project management skills with demonstrated ability in organizing, planning and executing development project from conception through implementation.
- Ability to understand major objectives and break them down into meaningful action steps.
- Ability to understand business strategy and formulate concise solutions to managed care problems.
- Proven ability to affect change and meet business goals, monitor progress and take corrective action when necessary.
- Proven ability and prior experience with negotiating and maintaining public and legislative relationships.

SCOPE INFORMATION

# Direct Reports: As Assigned

# Indirect Reports: As Assigned

Budgetary $ Responsibility: As Assigned

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.

AGP Job Title: COO- Plan

AGP Grade level: 26

AGP Compensation range: $180,000k - $240,000k- $300,00k

AGP MJO: 75-85k

AGP LTI: Based on performance

ermHO
]]>Mon, 13 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Richmond-COO-Health-Plan-Job-VA-23173/2593840/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Richmond-COO-Health-Plan-Job-VA-23173/2593840/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22738 # Positions 1
Location US-CA-Thousand Oaks
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/8/2013
Additional Locations ..

More information about this job:
Summary:

The incumbent will assist the Health Plan CEO in the fiscal and or operational management of the Health Plan. Responsibilities include serving as the liaison to all Virginia Beach support services and regulators, local network development, provider partnerships, provider relations, medical, case and quality management programs, performance management/improvement, budgets, complaints and appeals, regulatory and contractual compliance, monthly financials, and reporting. Provide input on overall strategic direction especially strategies affected by service delivery matters, operations, practices and policies.

Responsibilities:

1. Establish overall standards, policies and objectives for all Health Plans in accordance with applicable regulatory requirement; ensure alignment and support with overall mission, goals and objectives.

2. Act as a liaison to regulators for operational matters and to home office personnel by working cooperatively to ensure development and nurturing of a collaborative work environment to facilitate involvement in planning and operations as appropriate.

3. Serves as the liaison to all support services, Claims, Enrollment, MPS, Finance, Business Control, Med/Finance, Regulatory Compliance, IT, etc., in Virginia Beach. Participates in cross-company operational activities on an ad hoc (e.g., Service Center Audits) and ongoing (e.g., MOR; QOR) basis.

4. Accountable for the oversight of all health plan medical management programs including: concurrent review, pre-certification, discharge planning, case management, disease management, provider profiling, quality management, accreditation, health promotion and outreach. Facilitates and collaborates with NCC medical management staff to identify gaps and improve processes.

5. Accountable for the oversight of the design and development of provider contracts and partnerships to achieve quality, cost management, and strategic business development objectives; develops and negotiates strategic provider contracts on behalf of the Plan.

6. May be accountable for other areas of Plan operations including, but not limited to, marketing, operations, and specific products such as long term care.

7. Leads and manages the Plans performance management/earnings improvement activities. Assists in developing policy and programs to achieve business results through effective financial management.

8. Assists CEO with development and management of the Plan’s annual administrative, medical and capital budget process, monthly reporting and review of financials/accruals.

9. Coach and develop team members; adhere to the Company’s recruitment, selection, termination, and performance management processes. Act as advisor to subordinate managers or staff to help meet established schedules.

10. Manage the Plan’s complaint, appeals, pended claims, and claims research functions.

11. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in relevant field of work or equivalent experience in Business, Healthcare Administration or related field.

Preferred:
- Master’s degree.

Years and Type of Experience Required:

Required:
- At least 14 years of relevant experience including ten years of in-depth experience in the HMO/healthcare field.
- At least 10 years of leadership/management experience.

Language Skills

Required:
- English

Functional Competencies
- Comprehensive knowledge of managed care delivery systems and how they can work to improve quality of care and reduce costs.
- Strong financial management skills.
- Proven project management skills with demonstrated ability in organizing, planning and executing development project from conception through implementation.
- Ability to understand major objectives and break them down into meaningful action steps.
- Ability to understand business strategy and formulate concise solutions to managed care problems.
- Proven ability to affect change and meet business goals, monitor progress and take corrective action when necessary.
- Proven ability and prior experience with negotiating and maintaining public and legislative relationships.

SCOPE INFORMATION

# Direct Reports: As Assigned

# Indirect Reports: As Assigned

Budgetary $ Responsibility: As Assigned

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.

AGP Job Title: COO- Plan

AGP Grade level: 26

AGP Compensation range: $180,000k - $240,000k- $300,00k

AGP MJO: 75-85k

AGP LTI: Based on performance

ermHO
]]>Wed, 08 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Thousand-Oaks-COO-Health-Plan-Job-CA-91319/2587598/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Thousand-Oaks-COO-Health-Plan-Job-CA-91319/2587598/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22832 # Positions 1
Location US-VA-Norfolk
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/13/2013
Additional Locations ..

More information about this job:
Summary:

Provides leadership and direction for Behavioral Health Customer Service team. Responsible for the achievement and maintenance of all performance goals for the assigned teams and contributing towards the attainment of business unit and Customer Service goals and objectives. Supports and develops supervisory team to manage, develop and retain staff.

Responsibilities:

1. Plan, organize and manage all activities for assigned team, including organization, staffing, technology, training, budget, and reporting.

2. Ensure outstanding customer experience is provided by assigned staff by monitoring performance and providing coaching to improve quality.

3. Possess strong interpersonal skills to manage, develop, and retain staff.

4. Coordinate, communicate, and execute the policies, programs, practices and procedures of the department and company to the associates.

5. Develop and maintain member collateral and educational material content and contribute to provider materials. Assist in the coordination and distribution of materials.

6. Ensure interdepartmental communications are effective for receiving and diffusing information affecting the quality of services for members and providers.

7. Provide training and development support for assigned supervisors in the areas of time card management, performance management, and coaching/developing their associates.

8. Build and maintain positive working relationships with Quality teams, Claims and other key departments to resolve issues, claim or customer related issues and ensure associate and customer satisfaction.

9. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Required:
- Five years of experience in customer service or call center environment.
- One year of leadership/management experience or Successful completion of Amerigroup Leadership Development Program in lieu of above years of experience.

Preferred:
- Managed care experience.
- Four years of call center experience.

Certifications or Licensures

Required:
- N/A

Preferred:
- Six Sigma Green Belt certification

Language Skills

Required:
- English

Preferred:
- Spanish

Technical Competencies
- Computer Hardware, Software, and Applications/ Office Equipment-Advanced.
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks.
- Skills 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 and keyboard.
- Use of internet.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.
- Ability to use of complex applications of software to analyze and solve business problems.

Communication Skills
- Verbal, Written and Call Handling-Advanced
- Ability to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style in the preparation of verbal and written messages to business partners and customers.
- Ability to prepare, edit and clearly convey a variety of messages including presentations, training materials and updates.
- Ability to handle escalated issues to diffuse concerns through verbal and written messages. Heath Care Industry terminology
- Ability to understand basic health care industry terms.
- Ability to understand how an insurance claim works and use the explanation of benefits to explain details to providers and related business partners. Read, Interpret and Apply information-Advanced
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

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: 18-22

# Indirect Reports: Varies Budgetary

Budget Responsibility: 0

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
]]>Mon, 13 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Norfolk-Manager-Customer-Care-Behavioral-Health-Job-VA-23501/2594752/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Norfolk-Manager-Customer-Care-Behavioral-Health-Job-VA-23501/2594752/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22768 # Positions 1
Location US-VA-Chesapeake
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..

More information about this job:
Summary:

This is a senior operations management position requiring extensive knowledge in the areas of operational management and configuration of core business processing systems in a health plan services setting. This position requires using intelligence, operational management skills and judgment to anticipate problems and to provide solutions that exceed the demands of the customer’s operational expectations and business needs.

Responsibilities:

1. Manages the day-to-day configuration activities of the Business Solutions area of Health Plan Services. This includes crisis escalation and resolution, interaction with business owners and management of the intake, configuration and business analysis staff.

2. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements used to support health plan operations.

3. Coordinates and directs all configuration-related activities to meet project deadlines.

4. Ensures that service levels meet agreed-upon standards with business owners.

5. Sets, manages, and reviews performance goals and career development of staff.

6. Conducts gap analysis discovery between business requirements and system functionality.

7. Considers enterprise-wide impacts when recommending solutions.

8. Leads requirements development sessions with health plan business owners and other team members.

9. Participates in the quality assurance of all Business Solutions projects.

10. Acts as the business subject-matter expert to other implementation initiatives, including conversion, and interface development.

11. Provides operations management support for new development projects and market expansions.

12. Participates in the development of a configuration library of reusable configuration objects to use on future configurations.

13. Participates in the development of standard naming conventions and ensures compliance with these conventions.

14. Routinely trains configuration analysts on the model, change management and applicable standards.

15. Works with business owners to ensure that all application and technically-oriented issues relating to the configuration project are appropriately addressed.

16. Provides in-depth knowledge of company-wide business processes and advance knowledge of industry standard business processes and best practices.

17. Develops processes that consistently yield quantifiable and measurable improvements in the overall quality, and cost effectiveness for services provided.

18. Plans and balances resources vs. deliverables while executing on plan, within budget and with high quality.

19. Contributes to budget development and manages designated components of operating budgets in support of department budget management.

20. Clearly and confidently communicates both operational and business needs to all levels of the organization including Executive Management to line personnel.

21. Responsible for developing contingency plans to ensure department business plan objectives are met.

22. Adheres to departmental and corporate Policies and Procedures as outlined by Management.

23. Participates in relevant training programs when available and offered.

24. 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.

Preferred:
- Masters degree in business administration, information science, computer science, industrial engineering or a relevant area.

Years and Type of Experience Required:

Required:
- Seven or more years of technical and/or systems experience. Possesses 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.
- Demonstrated ability to supervise, motivate, develop and direct teams of operational staff which may include both business and technical resources.
- Ability to build a talented team and be expected to recruit, motivate and develop an exceptional team while working collaboratively within the organization.
- Demonstrated record of bringing together diverse functions and building effective teams.
- Excellent consultative, communication, leadership, negotiation, and motivational skills.
- Demonstrated ability to deliver quality customer service.
- Ability and willingness to step in and provide hands-on support when needed.
- Experience identifying and pursuing business opportunities for innovation within the organization.
- Must be positive and upbeat, bringing both professional focus and ability to motivate and direct teams to world-class service and quality.

Preferred:
- Facets configuration experience.
- Broad operational managed care background.
- Practical knowledge of the Software Development Life Cycle (SDLC) development methods.

Specific Technical Skills

Required:
- Two or more years of experience using MS Office.

Preferred:
- Experience using MS Visio and MS Project.
- Strong analytical background working with integrated data using a relational database management system or SQL for two or more years.

Other:

Required:
- Strong analytical, problem solving and quantitative analysis skills. Able to turn problems into opportunities for change.
- Ability to work in a fast paced environment managing multiple priorities simultaneously.
- Able to develop and manage multiple projects with minimal direction and supervision.
- Able to deliver a planned presentation to an audience.
- Able to create a presentation on a specific topic.
- Able to motivate others, provide innovative ideas and solutions, and promote the department vision for improvement and integrate that with others in the organization.
- Able to continually assess needs and implement measures that will ensure customer expectations are met or exceeded.
- Excellent interpersonal skills, including the ability to work with all levels of personnel including, but not limited to peers and Senior Management within the organization.
- Knowledge of managed care including, but not limited to claims adjudication and payment, medical management, provider fee-for-service reimbursement, capitation, billing, enrollment, and benefits.
- Strong negotiation and facilitation skills.
- Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION

# Direct Reports: 5 - 10

# Indirect Reports: 0 - 5

Budgetary $ Responsibility: TBD

KPI – Department Standards Yes - as determined.

PHYSICAL REQUIREMENTS
- 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, 06 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Chesapeake-Director-Health-Plan-Services-Job-VA-23320/2582915/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Chesapeake-Director-Health-Plan-Services-Job-VA-23320/2582915/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22903 # Positions 1
Location US-VA-Chesapeake
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

This is a senior operations management position requiring extensive knowledge in the areas of operational management and configuration of core business processing systems in a health plan services setting. This position requires using intelligence, operational management skills and judgment to anticipate problems and to provide solutions that exceed the demands of the customer’s operational expectations and business needs.

Responsibilities:

1. Manages the day-to-day configuration activities of the Business Solutions area of Health Plan Services. This includes crisis escalation and resolution, interaction with business owners and management of the intake, configuration and business analysis staff.

2. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements used to support health plan operations.

3. Coordinates and directs all configuration-related activities to meet project deadlines.

4. Ensures that service levels meet agreed-upon standards with business owners.

5. Sets, manages, and reviews performance goals and career development of staff.

6. Conducts gap analysis discovery between business requirements and system functionality.

7. Considers enterprise-wide impacts when recommending solutions.

8. Leads requirements development sessions with health plan business owners and other team members.

9. Participates in the quality assurance of all Business Solutions projects.

10. Acts as the business subject-matter expert to other implementation initiatives, including conversion, and interface development.

11. Provides operations management support for new development projects and market expansions.

12. Participates in the development of a configuration library of reusable configuration objects to use on future configurations.

13. Participates in the development of standard naming conventions and ensures compliance with these conventions.

14. Routinely trains configuration analysts on the model, change management and applicable standards.

15. Works with business owners to ensure that all application and technically-oriented issues relating to the configuration project are appropriately addressed.

16. Provides in-depth knowledge of company-wide business processes and advance knowledge of industry standard business processes and best practices.

17. Develops processes that consistently yield quantifiable and measurable improvements in the overall quality, and cost effectiveness for services provided.

18. Plans and balances resources vs. deliverables while executing on plan, within budget and with high quality.

19. Contributes to budget development and manages designated components of operating budgets in support of department budget management.

20. Clearly and confidently communicates both operational and business needs to all levels of the organization including Executive Management to line personnel.

21. Responsible for developing contingency plans to ensure department business plan objectives are met.

22. Adheres to departmental and corporate Policies and Procedures as outlined by Management.

23. Participates in relevant training programs when available and offered.

24. 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.

Preferred:
- Masters degree in business administration, information science, computer science, industrial engineering or a relevant area.

Years and Type of Experience Required:

Required:
- Seven or more years of technical and/or systems experience. Possesses 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.
- Demonstrated ability to supervise, motivate, develop and direct teams of operational staff which may include both business and technical resources.
- Ability to build a talented team and be expected to recruit, motivate and develop an exceptional team while working collaboratively within the organization.
- Demonstrated record of bringing together diverse functions and building effective teams.
- Excellent consultative, communication, leadership, negotiation, and motivational skills.
- Demonstrated ability to deliver quality customer service.
- Ability and willingness to step in and provide hands-on support when needed.
- Experience identifying and pursuing business opportunities for innovation within the organization.
- Must be positive and upbeat, bringing both professional focus and ability to motivate and direct teams to world-class service and quality.

Preferred:
- Facets configuration experience.
- Broad operational managed care background.
- Practical knowledge of the Software Development Life Cycle (SDLC) development methods.

Specific Technical Skills

Required:
- Two or more years of experience using MS Office.

Preferred:
- Experience using MS Visio and MS Project.
- Strong analytical background working with integrated data using a relational database management system or SQL for two or more years.

Other:

Required:
- Strong analytical, problem solving and quantitative analysis skills. Able to turn problems into opportunities for change.
- Ability to work in a fast paced environment managing multiple priorities simultaneously.
- Able to develop and manage multiple projects with minimal direction and supervision.
- Able to deliver a planned presentation to an audience.
- Able to create a presentation on a specific topic.
- Able to motivate others, provide innovative ideas and solutions, and promote the department vision for improvement and integrate that with others in the organization.
- Able to continually assess needs and implement measures that will ensure customer expectations are met or exceeded.
- Excellent interpersonal skills, including the ability to work with all levels of personnel including, but not limited to peers and Senior Management within the organization.
- Knowledge of managed care including, but not limited to claims adjudication and payment, medical management, provider fee-for-service reimbursement, capitation, billing, enrollment, and benefits.
- Strong negotiation and facilitation skills.
- Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION

# Direct Reports: 5 - 10

# Indirect Reports: 0 - 5

Budgetary $ Responsibility: TBD

KPI – Department Standards Yes - as determined.

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

ermIT
]]>Fri, 17 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Chesapeake-Director-Health-Plan-Services-Job-VA-23320/2604264/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Chesapeake-Director-Health-Plan-Services-Job-VA-23320/2604264/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22301 # Positions 1
Location US-NATIONWIDE
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 3/17/2013
Additional Locations ..

More information about this job:
Summary:

Ensures all aspects necessary to develop, maintain, and improve provider networks are met consistently to support the achievement of company goals. Functions include, but are not limited to, the identification, targeting, recruiting, contracting, and re-contracting with all types of providers including primary care physicians, specialist, hospitals, and allied services providers. Oversees strategic aspects concerning provider networks providing advice and guidance to the Health Plans. Responsible for maintaining compliance to company standards for areas influencing the management of provider networks. Provides leadership and development to team members within Network Development area.

Responsibilities:

1. Develops and recommends market specific provider network strategy to leverage opportunities and ensure achievement of organizational objectives.

2. Supervises the network development physician recruitment process and collaborates with multiple resources to convey opportunity and project a well-coordinated team.

3. Works collaboratively with the Plan and other cross functional areas to evaluate, recruit and contract with hospitals and organized provider groups.

4. Works collaboratively with finance in setting reimbursement guidelines including market specific models.

5. Creates continuity among all health plans in the areas of provider reimbursement, contracting, standards, and physician performance.

6. Negotiate provider contract language and reimbursement as needed.

7. Establishes standards, programs and process for provider network management, balancing best practices with knowledge of local market factors and needs to ensure success in all markets.

8. Works collaboratively with Business Development on new market development and entry.

9. Manages relationships with ancillary providers and ancillary vendors, and communicates contractual issues with appropriate enterprise departments.

10. Hires and develops staff, and ensures a positive working environment.

11. Performs other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in business administration, healthcare administration or related field or equivalent experience in lieu of degree.

Preferred:
- Master’s degree in relevant area.

Experience

Required:
- Minimum 12 years relevant health care experience with 7 years management/leadership experience.

Preferred:
- Knowledge of Medicaid and Medicare reimbursement methodologies.

Language Skills

Required:
- English



Functional Competitencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent program management skills, with the capability to effectively manage program and processes across multiple areas of the organization.

SCOPE INFORMATION

# Direct Reports: 2-5

# Indirect Reports: 10-15

Budgetary $ Responsibility: yes, varies.

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
]]>Sat, 11 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/VP-Network-Development-Job/2485328/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/VP-Network-Development-Job/2485328/?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 2013-22721 # Positions 1
Location US-LA-Metairie
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 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.

ermCS
]]>Wed, 01 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Metairie-Provider-Relations-Rep-I-Job-LA-70001/2576447/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Metairie-Provider-Relations-Rep-I-Job-LA-70001/2576447/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-21352 # Positions 1
Location US-TN-Nashville
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 12/3/2012
Additional Locations ..

More information about this job:
Summary:

Responsible for developing and expanding AMERIGROUP physician, physician group, IPA, hospital and ancillary networks. Responsible for negotiating reimbursement methodologies and contract language in existing and expansion markets. Ensure that all contracts meet AMERIGROUP standards, including feasibility of administration and reimbursement parameters. Support in the development of external recruitment provider materials.

Responsibilities:

1. Coordinate the management and growth of the hospital relations program or ancillary network that is in line with the health plan’s goals.

2. Coordinate with various departments to effectively implement and manage hospital relations or ancillary network development strategy.

3. Monitor hospital or ancillary network concerns, issues, and business opportunities and work with other functional areas of the Health Plan and Home Office regarding resolutions.

4. Management of Advocacy/Education Process with hospitals and ancillary networks including:
- Financial/Operational analysis regarding contract structure;
- Right-sizing of the ancillary provider network with providers that provide cost effective, quality services to AMERIGROUP members at the least administrative cost that meet contract requirements;
- Develop and implement processes/systems that ensure that hospitals and ancillary providers’ claims are paid accurately, timely, and on first submission;
- Coordination of all processes pertaining to contract implementation/maintenance.
- Coordination of market expansion initiatives;
- Negotiation of financial terms and contract language.

5. Identify quality-based, cost efficient processes and lead efforts to gain acceptance and ensure effective implementation.

6. Serve as key contact for targeted hospitals and other providers to ensure effective communication and response mechanisms.

7. Monitor national trends and local Health Plan market trends relative to Provider contracting, reimbursement, and service, make recommendations to modify current processes and assist to implement changes, when necessary.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in business administration, healthcare administration, or a related field or equivalent experience.

Years and Type of Experience Required:

Required:
- 5 years experience in a healthcare environment, preferably managed care with at least 1 year of leadership/management experience.
- Specific experience in network development, analysis, and contracting.
- Strong understanding of the healthcare industry, managed care, and provider financing.
- Experience contracting with large, complex provider organizations.
- Documented success in provider contracting, recruitment, retention, and service.

Preferred:
- Knowledge of Medicaid reimbursement and methodologies.

Specific Technical Skills

Required:
- Knowledge of hospital organizational structure including integrated delivery system, PHO’s IPA and Group Practices.
- Computational and analytical skills related to Provider contracting and healthcare cost management.
- Excellent computer skills including MS Office and Access.

Certifications or Licensures

Required:
- Must have a valid driver’s license and access to a motor vehicle.

Other:

Required:
- Excellent verbal and written communication skills.
- Excellent management skills.
- Strong analytical abilities.
- Proven project management skills with a demonstrated ability to manage multiple projects and meet deadlines.
- Appreciation of cultural diversity and sensitivity toward target population.
- Respect for and ability to work well with all levels of the organization and with the Provider Community.
- Ability to establish strategic vision, set expectations and provide clear direction to individuals or departments being managed.
- Understanding of the legal and regulatory environment relative to Provider Relations.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to travel on common carrier and adhere to AMERIGROUP’s travel policies.

ermHO
]]>Fri, 03 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Nashville-Manager-Contracting-Plan-Job-TN-37201/2304825/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Nashville-Manager-Contracting-Plan-Job-TN-37201/2304825/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22338 # Positions 3
Location US-NY-New York
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 3/21/2013
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
]]>Sat, 18 May 2013 05:31:00 GMThttp://www.amerigroup-jobs.com/job/New-York-Provider-Relations-Rep-II-Job-NY/2494367/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/New-York-Provider-Relations-Rep-II-Job-NY/2494367/?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 2013-22582 # Positions 1
Location US-NY-Brooklyn
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

Manages and coordinates the Enrollment Department functions to ensure the accurate and timely update of the Enrollment database, redirecting the focus of the department activities, as necessary, to meet deadlines. Oversees workflow and productivity, utilizing in-depth knowledge of all Enrollment policies and processes to guide and educate the Enrollment staff. Responsible for the timely notification to the Health Plans, other Corporate Departments and State representatives, as necessary, of Enrollment issues that may impact the timely load of enrollment data.

Responsibilities:

1. Manages staff to meet or exceed department goals, including productivity metrics, quality and timeliness standards as defined by department guidelines.

2. Reviews and analyzes contract changes for impact on enrollment processes; implements procedures in concert with contract requirements and federal and state laws.

3. Oversees the development of necessary user documentation and process flows to assist in the support and training of staff. Ensures documentation of all procedures.

4. Maintains in-depth, current knowledge of contractual and legal/regulatory requirements for multiple markets.

5. Assists in the development of policy and procedures for the Enrollment Department, and ensures adequate internal controls, including SOX and HIPAA controls, exist for all processes. Participates in market audits as needed.

6. Serves as Subject Matter Expert and liaison for technical projects.

7. Coordinates and interfaces with implementation team on new market/product implementations. Review and analyze contract changes for impact on the enrollment processes.

8. Oversee the development of necessary technical and user documentation to assist in the support and training of the staff. Ensure the documentation of all procedures.

9. Reviews and determines areas of improvement within the department and makes adjustments to achieve best performance possible, working with other impacted departments at the corporate and plan level as appropriate.

10. Responsible for recruiting, hiring, managing performance, ensuring compliance with all regulatory requirements, training and coach staff.

11. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in Health Care Management, Finance or Business or equivalent experience.

Years and Type of Experience Required:

Required:
- Five or more years experience in Enrollment in the healthcare industry, with at least one year of leadership/supervisory experience or successful completion of Amerigroup’s LDP program.

Preferred:
- Medicaid enrollment and membership reconciliation experience.

Language Skills

Technical Competencies Computer Skills and Office Equipment
- Advanced: Ability to use software and hardware of a computer to complete certain moderate to complex tasks.
- Skills 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 and keyboard.
- Use of internet.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.
- Ability to use of complex applications of software to analyze and solve business problems.

Spreadsheet Utilization and Management - Advanced
- Expert level of proficiency in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools. Ability to create spreadsheets in spreadsheets.

Industry Knowledge & Familiarity - Basic
- General understanding of the healthcare industry including who are providers (hospitals phy ofc, ancil), who are payors (insurance companies) and how the industry works
- General understanding of the claims process.
- More specific knowledge around reimbursement methodology, fee schedules and related terminology, e.g. per case, per diem, DRG, % of charges, etc. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping (DRG) codes, place of service codes (POS), etc.

Government Programs Specific Knowledge
- Medicare Medicaid programs, CHIP and LTC.
- Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

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.

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/Brooklyn-Mgr-Enrollment-Job-NY-11201/2546970/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Brooklyn-Mgr-Enrollment-Job-NY-11201/2546970/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22593 # Positions 1
Location US-FL
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

This position requires strong functional skills in technology, business process engineering and business planning and execution. Incumbents will provide day to day management to a team of associates working on configuration activities, and must have broad operational knowledge, effective communication skills and a experience in healthcare systems and processes.

Responsibilities:

1. Provides leadership by fostering and promoting configuration excellence, quality in the deliverables, process efficiency and innovation for the delivery of the configuration of business rules in multiple systems.

2. Manages day-to-day configuration activities within Health Plan Services. This includes crisis escalation and resolution, interaction with business owners and management of the intake, configuration and business analysis staff.

3. Develops and maintains relationships with Health Plan customers relative to configuration operations.

4. Works with internal stakeholders to resolve cross-functional issues related to configuration, claims payment, provider set-up, etc.

5. Ensures project deadlines are met and service levels meet agreed-upon standards with business owners.

6. Creates solutions with architectures that minimize complexity, effort, and maintenance while fully accomplishing the project and business objectives.

7. Communicates best practices for application configuration.

8. Allocates resources efficiently to meet multiple project deadlines and accomplish the objectives of the assigned initiatives.

9. Ensures that all department initiatives have clear business goals and success metrics.

10. Monitors and reports on the performance of the department including actual versus expected results and project duration.

11. Manages and develops staff by giving performance reviews, recruitment, career development and mentoring programs.

12. Performs 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.

Preferred:
- Masters degree in business administration, information science, computer science, industrial engineering or a relevant area.

Years and Type of Experience Required:

Required:
- Five years of configuration experience providing pricing and/or benefits configuration support with two years of leadership/management experience.

Certifications or Licensures

Preferred:
- Current Project management Professional (PMP) certification.

Language Skills

Required:
- English

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/Mgr-Health-Plan-Services-Job/2546966/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Mgr-Health-Plan-Services-Job/2546966/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22932 # Positions 1
Location US-IN-Indianapolis
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for daily management and coaching of Provider Services Team. Manages the functions relating to provider servicing, provider education and network development as appropriate in each Plan. Represents the Provider Relations Department at management meetings and interacts with management and staff of other departments as necessary.

Responsibilities:

1. Manages the Provider Services Team, including Provider Relations Representatives and Research Specialist(s) and other Provider associates as assigned in the Plan.

2. Monitors team activities to assure that staff meets performance standards and is operating effectively and efficiently.

3. Produces weekly/monthly/quarterly reports via Sales force CRM (or appropriate software per Plan) and reports on departmental metrics.

4. Responsible for handling escalated claims/operational issues and taking action to assure timely resolution of provider issues.

5. Evaluates the provider network to ensure appropriate access for membership and develops/executes recruitment plans.

6. Monitors staff workloads and makes recommendations on distribution of work.

7. Provides coaching and training to direct reports.

8. Recommends and/or drafts provider communications relative to health plan policies and procedures.

9. Oversees provider education activities including development of presentations for orientations and education.

10. Promotes positive relationships with the provider community and other AMERIGROUP departments.

11. Supports earnings improvement initiatives.

12. Manages the site visit process as part of provider credentialing.

13. Oversees provider marketing activities.

14. Interfaces with all other departments to ensure appropriate configuration of contracts, reimbursement rates, and benefits, and to address claims and operational issues.

15. Participates in standing meetings as necessary.

16. Ensures that inventory of provider communication materials is maintained.

17. Manages the provider complaint and Provider Relations databases.

18. Monitors provider complaints and makes recommendations to Directors and Vice President for addressing provider issues.

19. Develops and implements action plans regarding provider satisfaction results.

20. Leads provider profiling activities.

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 and at least one year of leadership/management experience OR;
- Successful completion of Amerigroup Leadership Development Program in lieu of above years of experience.

Specific Technical Skills

Required:
- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Knowledge of provider reimbursement methodologies, claims processing, billing practices, and fee schedules.
- Strong telephonic and customer service skills.
- Effective presentation skills.

Certifications or Licensures

Required:
- Must possess a valid driver’s license.

Other:

Required:
- Knowledge of healthcare terminology.
- Prior experience successfully managing people and projects.
- Ability to gain team support and motivate team to action.
- Excellent oral and written communication skills.
- Excellent problem solving skills.
- Ability to handle multiple tasks in a fast-paced environment.
- Appreciation of cultural diversity and sensitivity toward target population.

SCOPE INFORMATION

# Direct Reports: 1-8

# Indirect Reports:

Budgetary $ Responsibility:

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

ermHO
]]>Wed, 22 May 2013 05:00:00 GMThttp://www.amerigroup-jobs.com/job/Indianapolis-Manager%2C-Provider-Relations-Job-IN-46201/2611290/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Indianapolis-Manager%2C-Provider-Relations-Job-IN-46201/2611290/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS