http://www.amerigroup-jobs.com/feeds/accountant-Virginia-Beach-VA-jobs/ Custom RSS Feed for accountant-Virginia-Beach-VA-jobs Fri, 24 May 2013 22:59:10 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/feeds/accountant-Virginia-Beach-VA-jobs/ 720
Job ID 2013-22283 # Positions 1
Location US-VA-Virginia Beach
Search Category Finance
Type Regular Full-Time (30+ hours) Posted Date 3/13/2013
Additional Locations ..

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Summary:

Under general supervision, the Premium Billing Analyst III is responsible for complex state billings, accounts receivable and accounts payable functions as a result of the monthly premium reconciliation process for the Medicaid line of business. The primary focus of the position is the timely and accurate reconciliation of complex accounts, maintenance of the overall quality and accuracy of assigned databases and generation of monthly financial, State and Health Plan reports. This position performs complex analysis of reconciliation variances in assigned markets and takes appropriate action to resolve variances. The incumbent of this position is the primary contact for questions regarding assigned markets.

Responsibilities:

1. Detailed understanding of billing modules/processes from core Health Care systems and the Premium Reconciliation applications.

2. Detailed knowledge of premium reconciliation system and specific reports produced as a result of premium reconciliation.

3. Performs statistical analysis and reconciles premium payments received to internal billings for assigned markets.

4. Researches and analyzes financial variances as a result of premium reconciliation process and takes appropriate corrective action.

5. Tracks, ages and analyzes payment trends identified in the monthly premium reconciliation process for financial reporting.

6. Interfaces with the Finance Department, producing monthly reports to assist Accountants in identifying monthly accruals.

7. Documents and understands assigned market contracts for deadlines, reporting requirements, and configuration of Premium Reconciliation process/system.

8. Coordinates premium reconciliation schedule on a monthly basis to meet contractual or other specified deadlines.

9. Provides detailed financial support to all functional areas relative to premium reconciliation, acting as liaison/Subject Matter Expert.

10. Works with Management and Health Plans to identify premium/revenue enhancing opportunities.

11. Supports implementation of new markets and contract changes in premium reconciliation applications.

12. Interface with Operations Support staff to resolve system issues affecting premium reconciliation process and time table.

13. Other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in Finance or Accounting or equivalent experience

Years and Type of Experience Required:

Required:
- Minimum 5 years experience in analytical role

Preferred:
- Prior experience in a Health Care environment.
- Experience in Financial Analysis.
- Prior experience with financial reconciliations.
- Experience in a team oriented and / or productivity oriented environment,

Specific Technical Skills

Required:
- Demonstrated knowledge and experience using management information systems, database applications, word processing and spreadsheet applications.
- Proficient in the use of Microsoft Access.
- Detail oriented with strong analytical skills, ability to identify problems and develop solutions.
- Good communication, presentation and team work skills.
- Proven leadership skills.
- Ability to manage multiple tasks in a demanding work environment.

Other:

Required:
- Appreciation of cultural diversity and sensitivity towards target population

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
]]>Fri, 10 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Premium-Billing-Analyst-III-Job-VA-23450/2477771/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Premium-Billing-Analyst-III-Job-VA-23450/2477771/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22187 # Positions 1
Location US-VA-Virginia Beach
Search Category Health Care Administration
Type Regular Full-Time (30+ hours) Posted Date 3/6/2013
Additional Locations ..

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Summary:

The incumbent will serve as the primary clinical leader for Amerigroup’s dual initiative, and will be responsible for the program development, implementation, and management of Utilization Management, Case Management, Disease Management, Audit, Quality Management, Pharmacy Services, Mental Health, and/or Appeals and Grievances. The ideal candidate incumbent has at least 12 years of leadership experience in Medicaid/Medicare medical management (Nursing or Social Work), with Long Term Support Services (LTSS) and medical Geriatric experience, working in a matrix organization.

Responsibilities:

1. Directs and provides leadership for designing, developing, and implementing the local Plan integrated medical management program to meet the demographic and epidemiological needs of the population serviced.

2. Directs Healthcare Management Program for membership including disease management, case management, and utilization management.

3. Establishes objectives and annual goals in conjunction with the Medical Director to meet objectives established by the Plan CEO/COO and corporate HCMS.

4. Promotes understanding, communication, and coordination of Integrated Medical Management Programs across the health plan.

5. Works with Provider Relations, Quality Management and Health Promotions to develop and implement effective provider communications, quality assurance and member outreach programs.

6. Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.

7. Coordinates on a quarterly basis reporting of quality initiatives to all appropriate plan committees.

8. Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.

9. Monitors and makes recommendations for oversight of appropriate delegated services.

10. Develops the annual operating and capital budget: ensures that departments stay within budget and accounts for variances.

11. Works collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problems resolution.

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors Degree in a health care field or equivalent experience (equivalent experience equates to 6 years related experience in addition to the required 12 years experience).

Preferred:
- Masters Degree in a health care field, or
- MBA with Health Care concentration.

Years and Type of Experience Required:

Required:
- Minimum of 12 years relevant clinical work experience and at least 7 years of leadership/management experience preferably in a managed care setting , with at least 5 years of clinical experience (post Masters for Behavioral Health).
- Previous experience with NCQA accreditation and HEDIS reporting.

Certifications or Licensures

Required:
- RN, LCSW, LPC

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 5-30

# Indirect Reports: varies

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.

ermHO
]]>Thu, 16 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-VP-Healthcare-Mgmt-Svcs-Job-VA-23450/2467976/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-VP-Healthcare-Mgmt-Svcs-Job-VA-23450/2467976/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22777 # Positions 1
Location US-VA-Virginia Beach
Search Category Communications
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..

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Summary:

The Public Relations Specialist will provide support to a Communications team with various public relations and communication projects and tasks. This position will work collaboratively with senior leadership on the Communications team, Health Plan leadership, Consultants, Vendors and relevant business owners to promote “Real Stories,” various Company activities, Amerigroup Foundation events, corporate events and conferences across the health plans to enhance the Company’s image and brand. The Public Relations Specialist will implement the social media strategy, coordinating with department management to ensure its effectiveness and encouraging adoption of relevant social media techniques in the culture.

Responsibilities:

1. Collaborates with writers, web designers, graphic artists, developers and Subject Matter Experts (SMEs) to develop written material, collaterals, press releases, talking points, scripts, web content copy and other relevant materials to promote and inform the public and press of Company campaigns and events.

2. Creates communications strategy for prioritized health plan markets and business development markets.

3. Ownership for leveraging and highlighting Public Relations opportunities for the AGP Foundation—create corporate and health plan media advisories and press releases for each event.

4. Seeks opportunities to promote Amerigroup in our current and business development markets.

5. In collaboration with the department leaders and the external public relations company, will help manage the Amerigroup Speaker’s Bureau.

6. Assists the Public Relations team plan and conduct speaking engagements and other formal presentations with the general public, media, community groups, and employees. Research subject matter; provide support on key message development; and coordinate the development of audio and visual materials if required. Ensure communications are tailored to the audience.

7. Maintains working relationship with national, local and specialty media contacts germane to the health care industry, national business and other key outlets.

8. Strategizes and develops plan with contracted Public Relations firm, in pitching, booking, and coordinating interviews for Company spokesperson(s), executives and SMEs.

9. Supports the Company’s social media platform, internal framework, process and outreach. Providing daily management of all social properties including but not limited to Twitter, Facebook, LinkedIn and YouTube accounts based on company objectives and support for market messaging as well as other critical areas.

10. Perform other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in English, Journalism, Communications, Public Relations or other related experience in lieu of degree(s).

Preferred:
- Accredited in Public Relations (APR) designation or Accredited Business Communicator (ABC) designation.

Years and Type of Experience Required:

Required:
- Minimum three years relevant work experience.

Preferred:
- Minimum five years of related media relations experience; Health care industry and/or political experience a plus.

Language Skills

Required:
- English

Functional Competencies
- Proficient in Associated Press style writing standards.
- Ability to work independently, as a team member and collaborate with associates at all levels.
- Demonstrate sound decision-making, problem-solving, good judgment, research and presentation skills.
- Demonstrate effective verbal, written and broad communications experience with depth in media relations, issues management, and crisis communication.
- Maintain knowledge of government regulations and emerging web technology to ensure regulatory compliance.
- A creative and strategic thinker with broad public affairs and public relations experience.
- Demonstrate an enthusiasm for motivating people.
- Demonstrate analytical and persuasion/negotiation skills.
- Experience in strategic approach to communication and program development.

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.


]]>Mon, 06 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Public-Relations-Specialist-Job-VA-23450/2582910/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Public-Relations-Specialist-Job-VA-23450/2582910/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22819 # Positions 1
Location US-VA-Virginia Beach
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/10/2013
Additional Locations ..

More information about this job:
Summary:

Works independently and with considerable latitude to build collaborative working relationships with the leads of multiple corporate areas, the leadership at individual health plans, and with state employees as appropriate. Leverages these relationships combined with working understanding of the various corporate departments to evaluate cross-functional processes and coordinate activities on behalf of the health plans. Typically supports health plans that are large in size and/or have moderate complexity in terms of products, contracts, issues, etc. and/or multiple plans. Identifies issues and/or opportunities and develop action plans to address identified priorities. Demonstrates a high level of flexibility, managing multiple projects across health plans based on strategic priorities, ensuring that any potential issues and risks are communicated timely. Ensures accountability from all applicable entities – both at Corporate and the Health Plan.

This is a sourcing requistion. We will be looking to fill this role in the 3rd quarter of 2013.

Responsibilities:

1. Aligns corporate departments to systematically implement needed changes to support the strategic initiatives of each health plan.

2. Analyzes business processes or issues and recommends possible solutions and methods of executing plans.

3. Proactively identifies opportunities for process improvements in operations performed at Corporate or the health plan.

4. Provide support to Health Plan during operational audits – both internal and external.

5. Functions as an operational contact to the state as requested by the Health Plan, engaging team members as appropriate.

6. Coordinates and facilitates cross-functional issue resolution sessions emphasizing issue identification, root cause analysis, and eradication.

7. Escalates issues to senior leadership as appropriate when issues develop pertaining to state contract compliance. Follows up with the appropriate individuals for prompt resolution.

8. Reviews the performance of corporate departments against service level agreements and regulatory mandated performance guarantees.

9. Organizes communication between assigned health plans and the corporate departments to identify opportunities, ensure resolution and execution of solutions, and provide updates on strategic initiatives and plans.

10. Ensures action plans completed by the various corporate departments are enacted timely and communicated to the impacted Health Plan.

11. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Health Care or a related discipline. Equivalent experience is acceptable in lieu of a degree(s).

Preferred:
- Master’s degree preferred.

Years and Type of Experience Required:

Required:
- Five years relevant work experience, e.g. account management experience outside the healthcare industry or operational healthcare experience, and at least one year of leadership/management experience.
- Project Management, Account Management, or leadership experience in a medium to large size business environment.

Preferred:
- Experience in managed healthcare industry.

Certifications or Licensures

Required:
- N/A

Preferred:
- PMP
- Six Sigma or equivalent certification.

Language Skills

Required:
- English

Functional Competencies

Industry Knowledge and Terminology – have a solid understanding of the managed healthcare industry and the underlying supporting processes and systems, including who are providers, who are payors and how the industry works; knowledge around reimbursement methodology, fee schedules and related terminology, e.g. per case, per diem, DRG, % of charges, etc.

Cause and Effect Determination – ability to work with and get input from other areas to determine the source and root cause of errors, e.g. claims or reporting errors.

Governance Programs – have a solid understanding of Medicare/Medicaid programs, including eligible populations, general covered services, etc.

Contracts – ability to interpret and understand the language and terminology used in moderate to complex federal, state and provider contracts, i.e. contract covers multiple products, to determine operational requirements.

Software and Systems – ability to interact with and manipulate software applications and tools utilized to support healthcare operations; knowledge of claims payment system architecture and configuration.

Research – ability to utilize multiple resources, both internal and external, to identify and validate documentation and information used to resolve issues.

Industry Codes – have a solid understanding of code sets such as revenue codes, procedure codes, Diagnoses Related Grouping (DRG) codes, place of service codes, etc.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0

Budgetary $ Responsibility: 0-$1m

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
]]>Fri, 10 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Account-Manager-III-Job-VA-23450/2592122/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Account-Manager-III-Job-VA-23450/2592122/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2010-12454 # Positions 1
Location US-VA-Virginia Beach
Search Category Quality
Type Regular Full-Time (30+ hours) Posted Date 1/13/2012
Additional Locations ..

More information about this job:
Summary:

Develops, coordinates and executes the clinical quality accreditation and compliance programs for all Health Plans. Drives selection of indicators for monitoring and evaluating quality and appropriateness of care/service; assessing for continuous improvement in all activities, drives member satisfaction, and evaluates the effectiveness of interventions across the continuum of care to members as it pertains to clinical quality programs. Provides operational leadership for companywide member/provider satisfaction surveying, appeals, complaints and grievances compliance, and NCQA accreditation.

Responsibilities:

1. Provides leadership for implementation of the comprehensive Clinical Quality Management Program.

2. Establishes corporate and health plan quality accreditation and compliance objectives and annual goals.

3. Promotes organization-wide understanding, communication, education and coordination of all programs, initiatives and activities related to NCQA accreditation and compliance.

4. Oversees the companywide Accreditation, Appeals and Satisfaction QM Scorecard reporting including analyzing validity of plan and corporate aggregate data/reports from a CQI perspective and develops action plans for improvement.

5. Provides leadership for the development, implementation, and evaluation of the Corporate Trilogy Documents: Provides guidance and consultation to corporate medical management departments regarding annual evaluations and impact on accreditation; defines and implements action plans towards improvement.

6. Oversees the Medicaid Adult and Child CAHPS Survey, the Medicare CAHPS and HOS Surveys and the Provider Satisfaction Survey across the company; provides plan/aggregate analysis and impact information, leads and guides the Member Experience and Provider Satisfaction Committees towards satisfaction excellence.

7. Oversees the Appeal, Complaint and Grievances and Delegation Oversight process for the organization; oversight of standardization of core policy, procedures, processes, tools and systems to manage these functions; conducts quarterly and annually reporting specific to turn around times, overtime rates and complaints/thousand.

8. Supports the health plans’ External Quality Review Organization (EQRO) state audit processes; maintains an inventory of all health plan EQRO audit dates, results and any CAP’s. Proactively reviews and monitors plans progress towards improvement as well as conducts pre-audit readiness reviews; provides reporting and analysis quarterly.

9. Oversees and provides leadership for the companywide Quality Improvement Council (QIC); responsible for the corporate trilogy documents; provides leadership and direction regarding corporate and health plan clinical governance as it relates to quality accreditation and compliance; incorporates Patient Safety Program as part of duties and responsibilities.

10. Assists the Senior Vice President with the annual operating and capital budget to sufficiently meet departmental needs and ensure the department stays within budget and accounts for variances for costs and employee management for assigned areas of accountability.

11. Responsible for department and company Quality Management orientation and education programs.

12. Interviews, manages, evaluates, and develops new and existing departmental staff.

13. Perform other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Preferred:
- MSN or other Master’s Degree.

Years and Type of Experience Required:

Required:
- 10 years of relevant experience in quality management and/or utilization management in a managed care organization.
- 6 years of leadership/management experience Working knowledge of current managed care quality management principals and programs (i.e., Delegation Oversight, PIP, and Trilogy Documents).
- Familiarity/experience with NCQA & HEDIS programs.

Preferred:
- New market expansion experience.

Certifications or Licensures

Required:
- N/A

Preferred:
- Registered nurse with current license desirable.

Language Skills

Required:
- English

Preferred:
- N/A

Functional Competencies
- 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: 4-10

# Indirect Reports: varies

Budgetary $ Responsibility: 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.

CB1

ermHO
]]>Sat, 04 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-National-Vice-President%2C-Corporate-Quality-Management-Job-VA-23450/962042/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-National-Vice-President%2C-Corporate-Quality-Management-Job-VA-23450/962042/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-21168 # Positions 1
Location US-VA-Virginia Beach
Search Category Quality
Type Regular Full-Time (30+ hours) Posted Date 11/5/2012
Additional Locations ..

More information about this job:
Summary:

Responsible for developing, coordinating, and implementing Medicare quality initiatives to include implementing the Medicare Quality Management Program, monitoring and evaluation of quality of care/service, appropriateness, continuous improvement, and results of actions across the continuum of care to members. May also be responsible for developing, coordinating, and implementing corporate-wide task force initiatives and new model development as the result of Medicare growth and Dual Eligible populations.

Responsibilities:

The incoming AVP, Corporate Clinical Quality Management will make a difference, affect change, and provide a significant contribution to the future of AMERIGROUP by responding to the priorities of key stakeholders. Specifically, the candidate should be proficient in developing and managing:
- SNP Model of Care collaboration and submission process
- Development, implementation and analysis of CCIP and QIP programs
- Quality measure analysis
- Clinical quality programs specific to a Medicare population
- CMS audit activity as it relates to quality standards

Additional Responsibilities include:
- Assures initial and on-going compliance with State and Federal quality improvement/assurance requirements; specifically, assures compliance with CMS QIP, CCIP requirements as well as all requirements from Chapter 5 of the CMS Managed Care Manual
- Works with health plans and other corporate departments to develop a quality program for all LTSS lines of business.
- Accountable for implementation of programs to improve Amerivantage CMS Star Ratings

QUALIFICATIONS

Medicare quality managed care experience; A Master’s degree in a healthcare field is preferred, however a combination of Medicare, managed care and leadership experience will be considered in lieu of Masters preparation.

Other desirable personal attributes/values include:
- Ability to guide, educate and mentor quality leaders in multiple health plans specific to Medicare quality requirements
- Strong commitment to accountability and results
- Ability to develop and maintain productive relationships across the company
- Approachable and involved organizational leader committed to shared leadership
- Strong public speaking/presentation skills
- Reputation for ethical business practices
- Ability to engage, empower and encourage employees
- Change agent; openness to new ideas
- Ability to “hit the ground running”

Other desired competencies include:
- Clinical Analysis
- Performance Management
- Resource Management
- Strategic & Tactical Planning
- Effective Communication at all levels of the organization

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in a related discipline.

Preferred:
- MHA, MPH, MPA, or MSN

Years and Type of Experience Required:

Required:
- 10 years progressive experience in data mining and HEDIS management.
- Minimum of five years quality improvement and/or risk management in an MCO setting.
- Minimum of five years leadership/management experience.

Preferred:
- Previous NCQA MCO accreditation experience.
- Experience with the Medicaid/Medicare population, preferably with clinical quality and outcomes

measurement.

Specific Technical Skills

Required:
- Leader and working knowledge for data QC and data mining.
- HEDIS Management.
- Data Analysis.
- Data management skills.
- Proficiency in Microsoft Word and Excel.

Preferred:
- Previous NCQA accreditation and HEDIS reporting.
- Statistical data interpretation.

Certifications or Licensures

Preferred:
- CPHQ

Other:

Required:
- Advanced knowledge base in areas of health plan quality improvement and risk management.
- Strong knowledge base and experience in HEDIS and QI measurement sets.
- Data programming and mapping skills.
- Ability to work effectively with physicians and other health care providers as well as with multi-disciplinary teams across departments.
- Excellent written and verbal communication skills.
- Excellent analytical and problem solving skills.
- Ability to work in a team environment.
- Ability to develop and give presentations.

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.

CB1

ermHO
]]>Thu, 02 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Corporate-Medicare-Quality-Associate-Vice-President-Job-VA-23450/2252886/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Corporate-Medicare-Quality-Associate-Vice-President-Job-VA-23450/2252886/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-20714 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 9/27/2012
Additional Locations ..

More information about this job:
Summary:

Under general direction is responsible for assigned administration tasks and projects including equipment build out, system monitoring, and maintenance of servers and mass storage devices. Works with project teams to deploy hardware and software. Handles readily identifiable, clearly defined problems and follows standard practices and procedures in the research, isolation, resolution, and follow-up for routine system administration issues. Functions as a technical contributor working in a group of engineers, analysts, and technicians. This position is considered essential to operations and will be required to be available during an emergency. Additionally, the incumbent will be required to maintain an on-call status.

Responsibilities:

1. Responsible for executing the enterprise system strategy as it applies to the installation, maintenance, and management of the corporate LAN working within established procedures and/or protocols.

2. Contributes technical knowledge and experience in the area of local area networking, communications, and related hardware/software.

3. Develops and implements basic project plans with direction and supervisory review.

4. Performs system analysis, installation and support following standard practices and procedures.

5. Performs server software and hardware upgrades as needed and directed. Provides integrated team support and maintenance of system hardware and software.

6. Performs implementations and configuration of software and hardware.

7. Provides resolutions for standard systems level problems in relation to the corporate LAN.

8. Provides network operations support to include configuration management, performance analysis, and product evaluations. Assists engineering staff as assigned, in the evaluation of vendor products for future purchase.

9. Ensures system security is maintained and strengthened through implementation of current policies.

10. Monitors system level functions, capacity, and utilization; provides detailed reports to senior engineers.Assists with product testing and integration.

11. Maintains accurate documentation of systems infrastructure devices.

12. Performs other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associates Degree. Equivalent experience is acceptable in lieu of a degree(s).

Preferred:
- Bachelor’s degree.

Years and Type of Experience Required:

Required:
- A minimum of 3 years of relevant system network work experience within a complex information technology environment.

Certifications or Licensures

Required:
- A+ and MCP

Preferred:
- MCSE

Language Skills

Required:
- English

Technical Competencies

Computer hardware, software, applications – Basic
- Ability to maintain basic hardware, software and applications including applying patches and updates within a narrow discipline. Able to react to a user's need and add/delete a feature based on their stated need. Basic understanding of fundamental enterprise tools sets.

Infrastructure Performance Analysis – Basic
- Ability to monitor infrastructure systems for alerts and perform standard trouble-shooting. Understanding of incident management, i.e. ticketing, systems.

IT Security – Basic
- Understanding of basic enterprise best practices.

Behavioral Competencies

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

Show Drive and Initiative

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

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

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to lift 50lbs.
- Must be able to operate server maintenance tools.

D: JR

ermIT
]]>Tue, 21 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-System-Administrator-I-Job-VA-23450/2181708/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-System-Administrator-I-Job-VA-23450/2181708/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22087 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 2/25/2013
Additional Locations ..

More information about this job:
Summary:

Independently designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Receives technical guidance only on unusual or complex problems or issues. Functions as an active team member to implement and support various development, design and analysis initiatives employing prescribed methodologies, and follows the Amerigroup Quality Assurance process in the creation of work products. Competent to work at the highest technical level of all phases of applications programming activities.

Responsibilities:

1. Develops program logic for new applications or analyzes and modifies logic in existing applications. Identifies and creatively resolves complex problems.

2. Modifies moderate to complex application programs from detail specifications.

3. Applies a comprehensive knowledge and works independently to code, test, debug, document, implement and maintain software applications.

4. Creates a complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs.

5. Reads, interprets, creates and maintains complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

6. Assists in ensuring that system improvements are successfully implemented. Resolves complex design issues utilizing software development lifecycle and development methods.

7. Develops multiple, modular objects and the messaging interface between objects to create a complex software package. Reuses objects and creates object inventories.

8. Performs complex queries and updates of tables. Performs complex data modeling and database design with minimal oversight.

9. Defines requirements for application infrastructure including scalability, reliability, availability and serviceability and the trade-offs of each.

10. Performs analysis on new release features and analyze impact on the application and customer’s business process. Participates in potential vendor product/service evaluations to ensure technical requirements and performance measures are met.

11. Performs moderate to complex application administration and support.

12. Performs other duties as assigned/requested.

Qualifications:

EDUCATION REQUIRED

Education

Required:
- Bachelor’s degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Five years relevant work experience.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Advanced
- Thorough understanding of the core IT applications and systems and the inter-relationship among them. Advanced proficiency with all applicable company supported software applications and the associated infrastructure.
- Ability to use hardware and software of a computer to complete certain 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.

Programming Analysis - Advanced
- Thorough understanding of data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understanding of referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage. Knowledge of current and evolving application architecture trends to include infrastructure, software, database, networks and their interdependencies. Thorough understanding of Object oriented analysis and design. Thorough understanding of programming languages such as Objective C, Java, etc. Thorough understanding of environments used when programming such as .NET container or J2EE application server. Understands the strategic alignment of IT solutions with business objectives.

Project Management - Advanced
- Ability to develop and implement moderately complex project plans, and manage a project with supervision.

Behavioral Competencies

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

PHYSICAL REQUIREMENTS

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

ermIT
]]>Thu, 23 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Programmer-Analyst-III-Job-VA-23450/2447010/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Programmer-Analyst-III-Job-VA-23450/2447010/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22276 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 3/13/2013
Additional Locations ..

More information about this job:
Summary:

With guidance on unusual complex problems or issues, designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Functions as an active team member to implement and support various development, design and analysis initiatives employing prescribed methodologies, and follows the Amerigroup Quality Assurance process in the creation of work products. Competent to work on most phases of applications programming activities but requires instruction and guidance in phases.

Responsibilities:

1. Building on knowledge and experience works on more complex assignments to develop program logic for new applications or analyzes and modifies logic in existing applications where issues are less clearly defined.

2. Modifies moderately complex application programs from detail specifications. Identifies problems and possible solutions.

3. Applies a broad knowledge and works independently to code, test, debug, document, implement and maintain software applications.

4. Creates a moderately complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs.

5. Reads, interprets, creates and maintains moderately complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

6. Assists in ensuring that system improvements are successfully implemented. Resolves moderately complex design issues utilizing software development lifecycle and development methods.

7. Develops multiple, modular objects and the messaging interface between objects to create a moderately complex software package. Reuses objects and creates object inventory.

8. Performs complex queries and updates of tables. Performs moderately complex data modeling and database design with a small amount of oversight.

9. Ensures compliance and requirements of current license and support agreements are met. Perm analysis on new release features and analyze impact on the application and customer’s business process.

10. Performs moderately complex application administration and support.

11. Performs other duties as assigned/requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Two years relevant work experience.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Intermediate
- Understands the core IT applications and systems and the inter-relationship among them. Proficient with all applicable company supported software applications and the associated infrastructure.
- 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.

Programming Analysis - Intermediate
- Solid understanding of data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Conceptual understanding of referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage. Knowledge of current and evolving application architecture trends to include infrastructure, software, database, networks and their interdependencies. Solid understanding of Object oriented analysis and design. Solid understanding of programming languages such as Objective C, Java, etc. Solid understanding of environments used when programming such as .NET container or J2EE application server. Basic understanding of the strategic alignment of IT solutions with business objectives.

Project Management - Intermediate
- Ability to develop and implement basic project plans.

Behavioral Competencies:

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

PHYSICAL REQUIREMENTS

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

ermIT
]]>Fri, 10 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Programmer-Analyst-II-Job-VA-23450/2477770/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Programmer-Analyst-II-Job-VA-23450/2477770/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22597 # Positions 4
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/16/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

3. Prepares and submits productivity and savings reports.

4. Meets or exceeds established productivity and quality.

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

6. Work with health plans regarding overpayment Provider disputes.

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

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

9. Performs other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High school diploma or GED.

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

Years and Type of Experience Required:

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

Language Skills

Required:
- English

TECHNICAL COMPETENCIES

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

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

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

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

COMMUNICATION SKILLS:

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

BEHAVIORAL COMPETENCIES

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

PHYSICAL REQUIREMENTS

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

ermCS
]]>Wed, 15 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Recovery-Specialist-II-Job-VA-23450/2549311/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Recovery-Specialist-II-Job-VA-23450/2549311/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22608 # 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 2013-22732 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/2/2013
Additional Locations ..

More information about this job:
Summary:

Independently designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Receives technical guidance only on unusual or complex problems or issues. Functions as an active team member to implement and support various development, design and analysis initiatives employing prescribed methodologies, and follows the Amerigroup Quality Assurance process in the creation of work products. Competent to work at the highest technical level of all phases of applications programming activities.

Responsibilities:

1. Develops program logic for new applications or analyzes and modifies logic in existing applications. Identifies and creatively resolves complex problems.

2. Modifies moderate to complex application programs from detail specifications.

3. Applies a comprehensive knowledge and works independently to code, test, debug, document, implement and maintain software applications.

4. Creates a complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs.

5. Reads, interprets, creates and maintains complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

6. Assists in ensuring that system improvements are successfully implemented. Resolves complex design issues utilizing software development lifecycle and development methods.

7. Develops multiple, modular objects and the messaging interface between objects to create a complex software package. Reuses objects and creates object inventories.

8. Performs complex queries and updates of tables. Performs complex data modeling and database design with minimal oversight.

9. Defines requirements for application infrastructure including scalability, reliability, availability and serviceability and the trade-offs of each.

10. Performs analysis on new release features and analyze impact on the application and customer’s business process. Participates in potential vendor product/service evaluations to ensure technical requirements and performance measures are met.

11. Performs moderate to complex application administration and support.

12. Performs other duties as assigned/requested.

Qualifications:

EDUCATION REQUIRED

Education

Required:
- Bachelor’s degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Five years relevant work experience.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Advanced
- Thorough understanding of the core IT applications and systems and the inter-relationship among them. Advanced proficiency with all applicable company supported software applications and the associated infrastructure.
- Ability to use hardware and software of a computer to complete certain 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.

Programming Analysis - Advanced
- Thorough understanding of data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understanding of referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage. Knowledge of current and evolving application architecture trends to include infrastructure, software, database, networks and their interdependencies. Thorough understanding of Object oriented analysis and design. Thorough understanding of programming languages such as Objective C, Java, etc. Thorough understanding of environments used when programming such as .NET container or J2EE application server. Understands the strategic alignment of IT solutions with business objectives.

Project Management - Advanced
- Ability to develop and implement moderately complex project plans, and manage a project with supervision.

Behavioral Competencies

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

PHYSICAL REQUIREMENTS

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

ermIT
]]>Thu, 02 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Programmer-Analyst-III-Job-VA-23450/2578753/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Programmer-Analyst-III-Job-VA-23450/2578753/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22791 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/7/2013
Additional Locations ..

More information about this job:
Summary:

Acts independently under general direction, researches and fact finds to modify information systems for functional and operational areas. As a technical expert, responsible for analysis, design, development and testing of custom software, third-party application software, interface development and operational reporting development. Often acts as business expert and assists users in defining needs. Supports the initiation, amendments, renewal and terminations of contract negotiations. Uses a full technical knowledge of all phases of applications systems analysis. Services as subject matter expert providing assistance and training to less experience team members.

Responsibilities:

1. Devises or modifies procedures to solve complex problems considering computer equipment capacity and limitations, operating time, and form of desired results.

2. Develops complex web applications, which utilize Standard Query Language (SQL) data sources.

3. Develops multiple, modular objects and the messaging interface between objects to create complex software packages.

4. Creates complex design documents through the assessment of requirements. Assess alternatives to different designs and chooses best solutions to fit business needs.

5. Adheres to existing configuration management procedures and recommends/implements improvements to existing procedures. Adheres to and contributes to definition of good database design practices. Influences others to follow existing procedures.

6. Serves as a technical expert in development of IT architecture strategies for medium sized application infrastructures. Evaluates technology, performance, scalability, interoperability, reliability, availability, and serviceability in small to medium sized applications.

7. Reads, interprets, creates and maintains complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

8. Develops complex test plans, which include regression testing and packaging tests into consecutive steps based on logical dependencies. Writes, revises and verifies functional test plans for complex systems in a software application.

9. Evaluate and tests complex new/modified programs, applications and/or operating systems. Monitors system functionality and performance to ensure standards are met. Documents and tracks product defect and coordinates problem resolution with development and/or product vendors.

10. Performs complex SQL queries and updates tables. Manages complex data modeling and develops strategies to resolve complex data architecture and modeling issues.

11. Coordinates potential vendor product/service evaluations to ensure technical requirements and performance measures are met. Participates in RFPs activities, which include but are not limited to understanding business requirements; assess baseline/marketplace; construct, issues, and receives completed RFPs, evaluates potential vendor based on selected scoring model; evaluates cost benefit, and recommend vendor.

12. Performs other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:
- Bachelor’s degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).

Preferred:
- Master’s preferred.

Years and Type of Experience Required:

Required:
- Eight years related work experience.

Language Skills

Required:
- English

Technical Competencies:

Computer Hardware, Software and Applications / Office Equipment – Expert
- Comprehensive understanding of the inter-relationship among various IT applications and systems. Complete proficiency with all applicable company supported software applications. Moderate to comprehensive understanding of supported applications and all interdependencies (OS, network, server, workstations, etc.).
- Ability to use hardware and software of a computer to complete certain 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.

Applications System Analysis - Expert
- Comprehensive understanding of object oriented development language, object states and methods, and encapsulation. Solid understanding of variables, data types, expressions, control flow statements, arrays and strings. Understands data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understands referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage. Understands infrastructure associated with supported applications.

Project Management - Advanced
- Ability to develop and implement moderately complex project plans. Able to develop and implement budget plans.

Behavioral Competencies:

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

PHYSICAL REQUIREMENTS

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

ermIT
]]>Tue, 07 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Applicatn-Analyst-Princ-I-Job-VA-23450/2585347/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Applicatn-Analyst-Princ-I-Job-VA-23450/2585347/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22450 # Positions 1
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/1/2013
Additional Locations ..

More information about this job:
Summary:

With operations in Virginia Beach, the contact center delivers a variety of support resources to Amerigroup members.

At Amerigroup, leaders are focused on supporting our associates by connecting their daily activities with our mission, our vision and the customer service experience. Leaders are challenged to use their analytical skills to identify issues and proactively engage in problem solving that may impact our associates and members. Knowledgeable operations leaders focus on building relationships across functions in order to gain the insight required to support process improvement and people change management.

If you are looking for a way to make a difference and make use of your proven leadership capabilities, you are invited to further explore employment opportunities at Amerigroup.

As a leader in the contact center responsible for Customer Service, the incumbent will be responsible for the implementing policies and procedures which will result in outstanding customer experiences and is accountable for the tactical management of departmental staff. The incumbent is ensures the achievement of all performance goals, adherence to regulatory requirements, coordination of call center activities and implementation of operational processes.

Responsibilities:

1. Coordinates operational resources including staff, technology and training to ensure outstanding customer experiences are achieved while maintaining efficiency.

2. Develops policies, programs and processes to ensure successful communication and education of customers relating to telephonic, web and/or fax inquiries.

3. Plans, organizes and manages call center activities.

4. Generates and evaluates statistical reports on performance or areas of concern to identify trends impeding customer service and/or efficiency.

5. Partners with other operational leaders to resolve recurring issues and provide long term solutions.

6. Develops a high performance team through individual and team development in order to achieve established performance goals for the department.

7. Ensures operations comply with company policies, as well as federal and state regulations.

8. Coordinates the resolution and communication of all customer service issues presented by health plans or management.

9. Manages salary and expense budgets.

10. Establishes or maintains appropriate internal controls and effective performance reporting systems.

11. Ensures the integration of technology and personnel meets the evolving needs of our customers.

12. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Preferred:
- Master’s degree in Business or Healthcare Administration.

Years and Type of Experience Required:

Required:
- Seven years of customer service experience within a call center.
- Three years of leadership/management experience.

Preferred:
- Significant experience within managed care operations.

Certifications or Licensures

Preferred:
- Green belt certification.

Language Skills

Required:
- English

Preferred:
- Other languages as determined by business need.

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
- Integrates and balances big-picture concerns with day-to-day activities.
- Conveys a thorough understanding of own area's strengths, weaknesses, opportunities, and threats.
- Evaluates and pursues initiatives, investments, and opportunities based on their fit with broader strategies.
- Stays abreast of key competitor actions and their implications or threats to the business.

Make Sound Decisions
- Focuses on important information without getting bogged down in unnecessary detail.
- Probes and looks past symptoms to determine the underlying causes of problems and issues.
- Brings to bear the appropriate knowledge, information, and expertise in making decisions.

People Leadership

Develop / Support Organizational Talent
- Identifies the qualifications required for successful job performance.
- Provides honest, helpful feedback to others on their performance.
- Helps others identify and prioritize their development objectives.
- Promotes sharing of expertise and a free flow of learning across the organization.

Ensure Collaboration
- Discourages "we vs. they" thinking.
- Appropriately involves others in decisions and plans that affect them.
- Works to remove barriers to collaboration.
- Seeks to understand and address the concerns and interests of others with opposing viewpoints.

Results Leadership

Show Drive and Initiative
- Does not easily give up in the face of unexpected obstacles.
- Sets high standards of performance for self and others.
- Puts in extra effort and work to accomplish critical or difficult tasks.
- Tackles tough challenges or problems quickly and directly.

Accountability/Optimize Execution
- Conveys clear expectations for assignments.
- Delegates assignments to the lowest appropriate level.
- Monitors progress of others and redirects efforts when goals change or are not met.
- Holds people accountable for achieving their goals.

SCOPE INFORMATION

# Direct Reports: 3-8

# Indirect Reports: 125-150

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, 02 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Director-Customer-Care-Job-VA-23450/2523308/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Director-Customer-Care-Job-VA-23450/2523308/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22619 # Positions 40
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/18/2013
Additional Locations ..

More information about this job:
Summary:

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

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

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

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

Responsibilities:

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

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

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

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

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

6. Meets or exceeds established quality and production standards.

7. Reviews and responds to quality audits.

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

9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High school diploma or GED.

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

Years and Type of Experience Required:

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

Preferred:
- Two years of claims processing experience.

Language Skills

Required:
- English

Technical Competencies

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

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

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

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

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

Behavioral Competencies

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

PHYSICAL REQUIREMENTS

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

ermCS
]]>Sat, 18 May 2013 05:31:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Claims-Analyst-Job-VA-23450/2556791/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Claims-Analyst-Job-VA-23450/2556791/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22927 # Positions 1
Location US-NATIONWIDE
Search Category Medical Coding
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

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

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

9. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Years and Type of Experience Required:

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

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

Certifications or Licensures

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

Language Skills

Required:
- English

Functional Competencies

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

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Wed, 22 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Medical-Coding-Analyst-%28position-located-in-Virginia-Beach%2C-VA-or-Nashville%2C-TN%29-Job/2611282/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Medical-Coding-Analyst-%28position-located-in-Virginia-Beach%2C-VA-or-Nashville%2C-TN%29-Job/2611282/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22816 # 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, strategic planning and direction for vendor contracts within Cost Containment and related services. These functions include, but are not limited to research, contracting, implementations, recovery processes, and outcome reporting to department and senior operations management. Fosters collaborative relationships with each health plan and internal departments to ensure cost containment activity and recovery efforts are completed within all company, state and federal requirements.

Responsibilities:

1. Researches and identifies appropriate vendor solutions for cost containment initiatives.

2. Directs all vendor functions related to the identification and recovery of overpayments.

3. Negotiates contract terms and conditions with vendors primarily for but not limited to cost containment.

4. Ensures compliance with Amerigroup policies and procedures including Legal and Regulatory compliance and signoff. Ensures that the most effective financial terms are achieved, and that all state compliance-related issues are met.

5. Executes all vendor contracts from initial analysis and budgeting through implementation.

6. Monitors contract performance relevant to delivery schedules, applicable laws, payment provisions, performance metrics, and other pertinent requirements.

7. Responsible for the on-going evaluation and management of reimbursement recovery opportunities related to vendor projects through direct management and direction of staff.

8. Directs the research and resolution of escalated provider complaints, identifying trend patterns and creating corrective action plans to address root cause issues related to vendor projects.

9. Validates all vendor invoices in compliance with contract terms and recovery accuracy, ensuring recoupment is completed prior to payment.

10. Directs staff in the collection of provider negative balances, and interface with the provider, health plan provider relations staff, claims, legal, finance and other departments as needed.

11. Coordinates formal responses to vendor recovery questions/issues by health plans, states, etc. including matters of subrogation and coordination of benefits.

12. Achieves departmental/corporate goals through the ongoing selection, performance management and development of employees, including personal development and leadership skills.

13. 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:
- Eight years of experience with health insurance claims and/or recovery, with a minimum of three years in a managed care organization.
- Five years of leadership and/or management 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
- Integrates and balances big-picture concerns with day-to-day activities.
- Conveys a thorough understanding of own area's strengths, weaknesses, opportunities, and threats.
- Evaluates and pursues initiatives, investments, and opportunities based on their fit with broader strategies.
- Stays abreast of key competitor actions and their implications or threats to the business.

Make Sound Decisions
- Focuses on important information without getting bogged down in unnecessary detail.
- Probes and looks past symptoms to determine the underlying causes of problems and issues.
- Brings to bear the appropriate knowledge, information, and expertise in making decisions.

People Leadership Develop / Support Organizational Talent
- Identifies the qualifications required for successful job performance.
- Provides honest, helpful feedback to others on their performance.
- Helps others identify and prioritize their development objectives.
- Promotes sharing of expertise and a free flow of learning across the organization.

Ensure Collaboration
- Discourages "we vs. they" thinking.
- Appropriately involves others in decisions and plans that affect them.
- Works to remove barriers to collaboration.
- Seeks to understand and address the concerns and interests of others with opposing viewpoints.

Results Leadership Show Drive and Initiative
- Does not easily give up in the face of unexpected obstacles.
- Sets high standards of performance for self and others.
- Puts in extra effort and work to accomplish critical or difficult tasks.
- Tackles tough challenges or problems quickly and directly.

Accountability/Optimize Execution
- Conveys clear expectations for assignments.
- Delegates assignments to the lowest appropriate level.
- Monitors progress of others and redirects efforts when goals change or are not met.
- Holds people accountable for achieving their goals.

SCOPE INFORMATION

# Direct Reports: 4

# Indirect Reports: 50-60

Budgetary $ Responsibility: $4-10 million

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-Director-Cost-Containment-Job-VA-23450/2592118/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Director-Cost-Containment-Job-VA-23450/2592118/?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 2013-22147 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 3/14/2013
Additional Locations ..

More information about this job:
Summary:

Performs general research and analysis to support business operations. Determines best practices and suggests how to improve current practices. Assists in the development of recommendations to solve problems and issues related to business operations. Prepare presentations to report findings to a functional or project leadership. Gathers basic business requirements, performs first level analysis, supporting the development and testing processes of assigned functional areas.

This position supports the NCC call center.

Responsibilities:

Perform requirements gathering, analysis, and process and data flow diagramming for simple processes of low complexity.

1. Make recommendations for the Resolution of basic design and functional area organizational issues utilizing department resources, business development lifecycle and development methods and software applications.

2. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, and logical flow charts.

3. Evaluate and test basic new/modified programs, applications and/or operating systems to ensure adherence to operational specifications. Coordinate problem resolution with other departments or vendors.

4. Assist in the development of functional test plans used to verify specific system functions according to actual requirements and established guidelines.

5. Read and interpret a business policies and design documents.

6. Develop and run simple queries and reports for business analysis and trends.

7. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business Analyst role is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Experience in financial, functional analysis, or business analysis.
- Health Care industry experience.

Certifications or Licensures

Preferred:
- CCBA certification (Certification of Competency in Business Analysis)

Language Skills

Required:
- English

TECHNICAL COMPETENCIES
- Demonstrate a basic understanding of core applications and systems.
- Demonstrate proficiency with all applicable company supported software applications: QUEST is crucial to this role
- Able to provide professional and appropriate written information to internal and external customers.
- Able to initiate conceptual ideas with practical applications.
- Basic knowledge of the inter-relationship among various managed care operational areas.
- Basic knowledge of current technology trends.
- Able to develop and maintain customer relationships.
- Able to identify, analyze, and solve problems and to work with teams to solve problems.
- Able to develop and implement basic project plans.

Computer Skills and Office Equipment - Basic
- Computer skills refer to ability to use software and hardware of a computer to complete certain simple 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.

Spreadsheet Utilization and Management - Intermediate
- Proficient 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.

Database Utilization and Database Management
- Novice level.

Systems - Basic
- Understanding of system's utilization and basic retrieval of information and processing of the following systems:
- NetworX/Facets
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools - Basic
- Is aware and knowledgeable of tools and templates and is learning to use them on the job. Tools such as: TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General healthcare, who are our providers (hospitals phy ofc, ancil) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works.
- More specific knowledge around reimbursement methodology, fee schedules. Per case, per diem, DRG, % of charges, those terms. 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).
- Government Programs Specific Knowledge: o Medicare Medicaid programs, CHIP and LTC. o Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements - Basic
- Ability to prepare a requirements document that is relatively simple. Knows how to construct one and what basic elements are contained in a requirements document. Attends meetings with the business.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics - Basic
- Critical thinking and problem solving methods.

Project Management
- Learning the basics of managing projects and becoming familiar with PM tools, techniques and methodology.

Testing - Basic
- Functions independently in the creation of simple test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

BEHAVIORAL COMPETENCIES

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

PHYSICAL REQUIREMENTS

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

ermIT
]]>Sat, 11 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Operations-Business-Analyst-I-Job-VA-23450/2480268/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Operations-Business-Analyst-I-Job-VA-23450/2480268/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS