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Job ID: 2010-11973
# Positions: 1
Location: US-TN-Nashville
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

Configures and maintains provider information relative to an assigned market, serving as the main point of contact for the market. Supports the ongoing maintenance and data integrity of the provider configuration and provides research analysis as Subject Matter Expert for assigned market. Responsible for the provider configuration of the AMERIGROUP managed health care software systems and processing of advanced-level accounts. Assists in daily business operations including, but not limited to, departmental documentation and resolution of any outstanding provider issues pertaining to system configuration.

Responsibilities:

1. Responsible for defining provider demographic and regulatory affiliation set-up and maintenance for all providers and other advanced level or highly complex accounts in support of daily operations and global projects.

2. Processes and reconciles provider termination requests and related reporting requirements.

3. Processes and resolves pended inquiries and phone logs assigned to advanced level or highly complex accounts.

4. Responsible for data integrity of the provider sub-systems.

5. Maintains current knowledge of state guidelines and regulatory requirements, and all business rules pertaining to assigned market.

6. Works independently and with internal customers to research and resolve system related issues pertaining to provider data and configuration.

7. Communicates with physicians and their office staff, IPA's, hospitals, and other provider organizations to request and validate provider information.

8. Meets or exceeds individual, team, and department productivity metrics, quality, and timeliness standards as defined by department guidelines.

9. Works with and supports Management and team members in the provider configuration and implementation of all approved market specific or global projects to include; same-store growth, new market expansion, acquisition activities, and system design initiatives.

10. Recommends standard best-practice department policies and procedures to create and maintain replicable processes within the department and provides input for training materials and job aids.

11. Responsible to communicate and work with internal and external customers and resolve issues for assigned markets.

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

13. Supports new hire and refresher training of associates.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required: High School Diploma

Preferred: College Degree

Years and Type of Experience Required:

Required: 1 to 2 years of provider configuration experience or comparable healthcare experience

Preferred: 3 or more years of provider configuration experience or comparable healthcare experience.

Technical Skills

Required: Intermediate/advance knowledge in Microsoft suite, including but not limited to Word, Excel

Preferred:

- Amisys and/or Facets configuration skills preferred.
- MS Access, Powerpoint, Visio

Other

Required:

- Strong analytical and organization skills
- Excellent verbal and written communication skills
- Intermediate understanding of core systems and processes of assigned market area(s)
- Demonstrated proficiency in navigating provider sub systems

Preferred: Knowledge of managed care including, but not limited to, provider data and configuration, enrollment, and credentialing

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 a computer.
- Must be able to operate a telephone]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Nashville-Provider-Information-Spec-III-Job-TN-37201/886601/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Provider-Information-Spec-III-Job-TN-37201/886601/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11884
# Positions: 1
Location: US-TN-Nashville
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

The Member Outreach Associate is responsible for providing support for Medicare quality initiatives and regulatory/contractual requirements. Support includes telephonic and in-person outreach to members who are identified as requiring outreach services. May provide assistance to quality management, and performance data collection and recording.

Responsibilities:

1. Provide members with information on how to access preventive and health maintenance services while identifying barriers to care.

2. Support the implementation of quality improvement preventive health and chronic condition management interventions.

3. Track, trend, and report on Medicare established quality activities, monthly as assigned. Records and reports all provider outreach activity.

4. Promote and distribute educational materials and program information to members.

5. Assists members in making follow-up appointments with his/her Primary Care Physician (PCP) and/or Specialist as indicated by the HEDIS guidelines.

6. Provides telephone follow-up to ensure members have seen their PCP and completed or are in process of completing their treatment plan or preventive care services as defined by the PCP or guidelines

7. Promotes and supports the PCP relationship.

8. Refers issues and concerns about members to the health plan Case Management staff as soon as identified.

9. Serve as a referral agent to internal services and external CBO's.

10. Assist in the maintenance of the SSO member registry database.

11. Performs other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE:

Education Required:

- High School diploma required with at least one year of experience in healthcare or managed care industry

Preferred:

- College degree or equivalent preferred.

Years and Type of Experience Required: Required:

- Some understanding of medical terminology.

Preferred:

- Experience in a health related service such as community outreach worker, home health aide, etc.

Specific Technical Skills Required:

- Computer literacy in excel and word.

Certifications or Licensure Required:

- Valid Driver's License and clean driving record

Other Required:

- Good verbal communication skills.
- Professional telephone skills.
- Community awareness and knowledge.
- Appreciation of cultural diversity and sensitivity towards targeted populations.
- Must be organized and able to multi-task.
- Must be able to work independently.
- Must have excellent communication skills and the ability to communicate effectively with internal and external customers.

Preferred:

- Bilingual skills in Spanish a plus.

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.
- Must be able to collect medical records
- Willing to work in community]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Nashville-Outreach-Assoc-Job-TN-37201/886553/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Outreach-Assoc-Job-TN-37201/886553/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12077
# Positions: 1
Location: US-TN-Nashville
Search Category: Healthcare Management Services
Type: Regular Full-Time (30+ hours)
Posted Date: 8/3/2010

More information about this job:

Overview:

JOB SUMMARY: The AVP of Quality Management provides leadership in the development, coordination, implementation, and evaluation of the continuous quality improvement initiatives throughout the company in the areas of quality of care, quality of service, and provider/member satisfaction. Provides direction, leadership and education for compliance with NCQA standards to achieve and maintain NCQA accreditation. Maintains liaison with state and federal regulatory agencies. Supports health plan coordination of the quality management program across the company by sharing replicable technology, benchmarking, and best practices. Works to establish and promote a culture of organizational excellence.

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Directs and provides leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan ensuring the demographic and epidemiological needs of the population served are met. 2. Establishes objectives and annual goals in conjunction with the CEO and Medical Directors. 3. Oversees implementation and evaluation of the scope of the quality management program. 4. Promotes plan-wide understanding, communication, and coordination of the quality management program. 5. Directs and provides leadership for Plan compliance with NCQA standards. 6. Provides leadership for the interpretation of results and development of improvement action plans arising from provider and member satisfaction surveys. 7. Serves as a resource for design of quality improvement studies, indicators, data collection, and data trend analysis/interpretation. 8. Provides leadership in developing, monitoring, and evaluating HEDIS improvement action plans. 9. Participates in market development activities through due diligence activities. 10. Provides leadership for health plan QM activities through sharing of replicable technology/benchmarking/best practices, assisting with review preparation, and providing guidance in quality improvement activities. 11. Provides coaching for development of QM personnel. 12. Works to establish and promote organizational excellence throughout the health plans. 13. Monitors compliance with State and Federal quality improvement/assurance requirements. 14. Evaluates and makes recommendations for oversight of delegated services. 15. Develops the QM department annual operating and capital budgets to sufficiently meet departmental needs, and ensures the department stays within budget, and accounts for variances. 16. Interviews, manages, evaluates, and develops new and existing departmental staff. 17. Recognizes and utilizes appropriate channels for communication, encourages two-way communication, and encourages staff to participate in creative program development. 18. Effectively communicates information to superiors, team members, and other appropriate staff in a timely, accurate, and courteous manner. 19. Provides leadership/facilitation for groups as needed. 20. Represents Quality Management through group presentations on various topics for a variety of internal and external audiences. 21. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE: Education ' Bachelor Degree required. ' MSN, MPH, MPA preferred. Years and Type of Experience Required: Required: ' Minimum of 10 years experience in quality management, quality improvement, risk management, and/or utilization review in HMO setting and 5 years of leadership/management experience. ' Previous NCQA accreditation and HEDIS reporting experience required. Specific Technical Skills ' Required: Knowledge of basic computers including word processing and spreadsheets. ' Preferred: Knowledge of data base applications preferred. Certifications or Licensure Required:. Preferred: ' Current RN state license (or as required by Plan) ' CPHQ preferred. Other ' Strong knowledge base in areas of quality improvement, accreditation, HEDIS, satisfactory survey process, and organizational improvement. ' Excellent written and verbal communication skills. ' Ability to work effectively with physicians and other health care providers as well as with multi-disciplinary teams across department lines. ' Excellent problem solving skills. ' Demonstrates strong organizational skills. ' Strong leadership, coaching, and staff development skills. ' Ability to develop and give presentations and to facilitate groups. ' Ability to handle multiple tasks. ' Appreciation of cultural diversity and sensitivity towards target population. SCOPE INFORMATION ' # Direct Reports: Will likely have direct reports. ' # Indirect Reports: Will likely have indirect reports. ' Budgetary $ Responsibility: May have budgetary responsibility. PHYSICAL REQUIREMENTS ' Must be able to operate a computer. ' Must be able to operate a phone. ' Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies]]> Sat, 04 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Nashville-AVP-Quality-Management-Job-TN-37201/894924/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-AVP-Quality-Management-Job-TN-37201/894924/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12093
# Positions: 16
Location: US-TN-Nashville
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/5/2010

More information about this job:

Overview:

Responsible for responding to either inbound inquiries or outreach calls from/to potential and existing AMERIGROUP members and providers. Responsibilities include providing accurate information/education/resolution about eligibility status, benefit coverage, provider network, credentialing status, authorization/referral status, demographic changes and all other non-claim issues.

Responsibilities:

1. Function as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff.

2. Provide effective customer care through superior customer service methods, problem solving and real time issue resolution that promotes member and provider retention.

3. Interact with provider community and various departments to resolve issues involving the membership

4. Explain benefits, eligibility status, and member enrollment processing procedures to callers.

5. Assist with activities to ensure membership's continuity of care.

6. Assist providers with credentialing status questions.

7. Verify the status of authorizations and/or referrals

8. Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls) and complete health assessments for plan case management (Early Case Findings and Healthy Beginnings).

9. Process complaints, following established guidelines.

10. Participate in conducting membership surveys.

11. Assist company departments with various tasks (complications) involving the membership.

12. Must become familiar with and maintain knowledge of state guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.

13. Provide mentoring and support to new associates once proficient.

14. Other duties as assigned.

Qualifications:

Education

Required:

High School Diploma or equivalent

Preferred:

Some college courses or degree.

Years and Type of Experience Required:

Required:

Minimum 2 years experience in customer service and/or call center environment.

Preferred:

Managed care experience.

Specific Technical Skills

Required:

Ability to work independently and use reference material to resolve member's benefit related questions.

Basic computer skills and ability to navigate in Windows environment.

Other:

Required:

Must learn and fully understand the managed care products.

Strong interpersonal skills.

Ability to multitask, demonstrate initiative and respond proactively to resolve problems.

Excellent written and verbal communication skills.

Detail oriented with strong organizational skills.

Self disciplined and self motivated.

Strong problem solving skills.

Ability to handle crisis calls and irate callers calmly and effectively.

Team player.

Appreciation of cultural diversity and sensitivity towards target population.

Ability to demonstrate HIPAA compliance.

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]]> Sun, 05 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Nashville-Customer-Care-Rep-I-NCC-Job-TN-37201/900728/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Customer-Care-Rep-I-NCC-Job-TN-37201/900728/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11827
# Positions: 1
Location: US-TN-Nashville
Search Category: Sales & Marketing
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

The Medicare Account Representative is responsible educating seniors and the community about Medicare products; generating enrollment leads and referrals; enrolling seniors in the AMERGROUP Medicare Advantage plan; and presenting plan information at community-based seminars. This position is responsible for developing and maintaining leads which includes timely reporting and documentation of results for use by management. At all times, this position must conduct themselves in full compliance with state and federal regulatory requirements.

Responsibilities:

1. Meets sales and sales development goals as assigned by management.

2. Submits enrollment applications in a complete and timely manner.

3. Conducts telemarketing activities, both inbound and outbound to respond to inquiries, generate appointments, and follow-up on leads, referrals, and re-marketing opportunities.

4. Responds and follows-up on leads which include entry of data into AMERIGROUP's Sales Tracking System.

5. Coordinates and implements strategies in an assigned territory and growing membership through face-to-face sales enrollment meetings, presentations, community and provider education sessions and social service outreach to existing and potential members.

6. Develops and maintains new contacts and/or partnerships in the community.

7. Conducts in-home presentations and community-based presentations and performs other activities in an effort to gain members and maintain and/or established positive relationships with providers, community and faith based organizations.

8. Develops and maintains new and existing provider and community-based organization relationships.

9. Participates in marketing events and exhibits as needed.

10. Identifies and enlists the cooperation of individuals, groups, social service agencies and other community organizations in educational and outreach activities.

11. Supports health and wellness education activities; referral of members to health education programs.

12. Acts as a viable resource to the membership and the community as needed.

13. Identifies cultural issues regarding current and potential members; communicates those issues and concerns to management immediately.

14. All other professional duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE: Education

Preferred: BS/BA degree

Type of Experience

Required: 3 yrs direct consumer services sales experience, if highest education level is High School.

Preferred: Direct experience selling Medicare insurance products to seniors.

Specific Technical Skills

Preferred: Experience working with Microsoft office - Excel and Word

Certifications/Licensure:

Required: Health and/or Life Producer's license, as required and issued by the state (must have a valid license prior to the first day of employment); Must possess a valid driver's license, motor vehicle insurance and have access to a motor vehicle

Knowledge and Skills:

- Self-starter with the ability to work with limited supervision;

- Medicare, Medicaid and CHIP program knowledge desired;

- Excellent verbal and written communications skills; bilingual a plus (Spanish-English);

- Strong time management, organizational and follow up skills required;

- Must exhibit sensitivity towards the target population including experiences selling or caring for seniors;

- Must be creative, innovative and have excellent interpersonal skills;

- Must be self-oriented, flexible, enthusiastic and energetic]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Nashville-Account-Representative-Medicare-Advantage-Job-TN-37201/886536/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Account-Representative-Medicare-Advantage-Job-TN-37201/886536/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12054
# Positions: 1
Location: US-TN-Nashville
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 7/30/2010

More information about this job:

Overview:

JOB SUMMARY: The Account Executive (AE) is responsible for Provider Quality Incentive Program initiatives. Account Executive communicates, analyzes and formulates agreement with Claims, Clinical Informatics, Compliance, Finance, Health Plan Healthcare Management Services and Provider Relations, Medical Economics, and Quality Management to reward our large-panel primary care providers and groups who meet quality benchmarks and improvement targets, as well as medical cost management targets. Program quality indicators have been selected based on an analysis of the greatest quality improvement opportunities for our members, and will be measured in a HEDIS-like fashion.

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Conducts market analysis to define large-panel primary care providers and groups who meet quality benchmarks and improvement targets, as well as meets criteria for medical cost management. 2. Assesses and analyzes quality and medical cost data results and manages the Provider Quality Incentive Program (PQIP) on behalf of local health plan. Stays abreast of program development and provides an ongoing objective evaluation of important aspects of data findings to report potential issues or concerns to upper management. 3. Works collaboratively with appropriate staff at various stages in the process. Functional areas are: Claims, Clinical Informatics, Compliance, Finance, Health Plan Healthcare Management Services and Provider Relations, Medical Economics, and Quality Management to analyze data. Make determination for next steps. 4. Educates and trains AGP staff, participating provider & staff, and associated AMERIGROUP leadership on their responsibilities in carrying out the quality improvement program. Chair functional area meetings to review analysis while maintaining Program integrity and in preparation for presentations to Committee. 5. Collects, analyzes and summarizes performance data, identifying opportunities for improvement and present finding to QPIP Committee. 6. Conducts meeting(s) with large-panel primary care providers and groups before and after they enter the QPIP Program. Monitor quality data and improvement targets as well as medical cost management targets. Review detailed analysis with provider to promote improvement in quality and management of service delivery. 7. Reviews new or modified program enhancements to determine if proposed processes are and/or will continue performing according to program specifications; if results potential yield a negative impact, conform by changing aspects where necessary. Recommends program improvements or corrections QPIP Committee. 8. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. Works with Provider's staff and AMERIGROUP staff (local and/or corporate) to resolve the issue and monitor recurrence. 9. Assist with training and mentoring of the Provider Relations Representatives as needed to ensure departmental success and effective team work. In the absence of management, acts as the lead or senior associate in the department or for the assigned team. 10. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force). 11. Performs other duties and special projects as assigned.

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: Bachelor's degree in Business Administration & Management, Healthcare Administration and Management, or Nursing Preferred: Certified Medical Office Manager (CMOM), Quality Improvement Analyst/Mgr. Years and Type of Experience Required: Required: Minimum 5 years experience of practice manager, business analyst, claims manager, healthcare business office manager or outpatient clinic administrator Preferred: 3 years as a member of Practice Management Institute Specific Technical Skills Required: ' Ability to cultivate and maintain positive internal and external relationships ' Ability to work independently ' Ability to analyze and interpret statistical data ' Ability to effectively communicate statistical and qualitative interpretations in a non-offensive manner to medical professionals and staff ' Ability to guide the provider to better performance ' Experienced in CPT and ICD-9 Coding ' Experienced in running reports and developing presentations ' Excellent verbal and written communications skills ' Effective management skills ' organization, planning, setting goals and objectives, time management ' Effective leadership skills ' Excellent interpersonal skills ' Excellent social skills ' Thorough appreciation of cultural diversity and sensitivity toward target populations Certifications or Licensure Required: Preferred: CMOM, Certified Medical Coder (CMC), Registered Nurse or Licensed Practical Nurse Other Required: Preferred: SCOPE INFORMATION Item Measure ' # Direct Reports ' # Indirect Reports ' Budgetary $ Responsibility PHYSICAL REQUIREMENTS ' Must be able to operate a computer ' Must be able to operate a telephone ' Must be able to conduct and participate in meetings ' Must be able to travel on common carriers and adhere to AMERIGROUP's travel policies]]> Tue, 31 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Nashville-Provider-Account-Executive-Job-TN-37201/892049/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Provider-Account-Executive-Job-TN-37201/892049/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12248
# Positions: 1
Location: US-TN-Nashville
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 8/26/2010

More information about this job:

Overview:
JOB SUMMARY: The Manager of Appeals and Grievances leads the regulatory compliance and operations activities of AMERIGROUP's Medical Necessity Appeals and Complaints (Grievances) process and tracking. The Manager provides expertise and leadership for AMERIGROUP's regulatory/contractual obligations of the multiple state regulatory bodies. Requires frequent monitoring and problem solving such as work flows, electronic systems to manage these processes and implementation of solutions with the Health Plans and Corporate entities to ensure regulatory and accreditation needs are met. This position manages the associates in the Complaints and Grievances component of the QI department.

Responsibilities:
PRIMARY RESPONSIBILITIES: 1. Manage the Medical Necessity Appeals (MNA) and Complaints process and reporting: · Provide management and leadership with information and tools for strategic planning and decision making for Amerigroup complaints and medical necessity appeals . · Provide expertise as the AGP corporate subject matter expert with Health Plans and corporate entities and Regulatory for complaint tracking and MNA. · Develop and maintain productive working relationships with key regulators and Health Plan contacts that leads to a mutual accountability to benefit company-wide operations and activity. · Subject matter expert/advisor on MNA and complaints requirements and programs, including state-specific/federal requlations and NCQA requirements. · Oversight of all MNA activity including MNA external reviews, including State Fair Hearings, , Accreditation compliance and policies associated with these processes. 2. Assess, communicate and ensure associate understanding of state and federal regulations, legislation and regulatory requirements that impact AGP-wide business activity and operations. 3. Develop and maintain resource tools for internal education, and compliance assessments. 4. Work with AGP Compliance Dept. to lead AGP and vendor preparations for performance assessments, and internal delegation and compliance audits' · Prepare AGP and vendor operational leads for targeted audit activity. · Coordinate and organize desk review submissions and on-site audit materials. · Lead on-site assessment and audit activity, if needed. · Facilitate development of corrective action plans ('CAPs') and oversee CAP implementation. · Interact with individual Health Plan audit and enforcement agencies to correct deficiencies and minimize administrative actions and sanction activity. 5. Submissions of reports for MNA and complaints/grievances to the appropriate committees and internal departments. 6. Provide feedback on regulatory filings and member correspondence pertaining to MNA and complaint management. 7. Advises AGP markets and corporate groups on the definition of MNA and complaints eliminating grey areas of confusion with provider disputes and MNA. Uses clinical expertise in problem solving for complaint and MNA follow-up needs. 8. Oversee market expansions and new market activities from an operational perspective, developing processes and policies to support the RFP, regulations, or EQRO requirements. 9. Provide management of associates with motivational environment by establishing clear expectations, communicating specific performance feedback and providing timely and thorough performance appraisals. · Interview, hire and train support staff · Counsel support staff and take appropriate disciplinary action. · Develop and administer team objectives, priorities and strategic action plans for achieving goals.

Qualifications:
EDUCATION AND EXPERIENCE: Education Required: ' Bachelor's degree. Experience in lieu of degree is acceptable ' Experience with medical necessity appeals process and regulation. Preferred :Bachelor's degree in nursing. Registered Nurse with managed care experience with appeals and grievances process Years and Type of Experience Required: Required: ' 5 years of relevant work experience in the healthcare industry, preferably a managed care environment ' 3 years of leadership and management experience Preferred: ' 1-2 years experience managing appeals and/or complaint processes for large company ' Extensive knowledge of accreditation requirements for MNA and complaints, including NCQA and AAAHC ' Extensive knowledge of federal and state managed care regulations Preferred: Specific Technical Skills Required: ' Intermediate level Microsoft Office Suite skills. Specifically Word and Excel. ' Report development skills including detail needed for specific market and summary for executive reporting.. Preferred: Report presentation skills for small and large groups Certifications or Licensure Required: Preferred: Registered Nurse (RN ) Other Required: ' Strong analytical and organizational skills. ' Excellent verbal and written communication skills. ' Ability to analyze, interpret, and summarize contracts, regulations, policies/procedures, reports and legal documents. ' Ability to respond to questions/concerns from internal customers, External Quality Review Organizations (EQRO) and regulatory agencies. ' Present company position in understandable and unambiguous manner in formal and informal presentations. ' Problem-solver ' identify root cause, recommend options and implement/negotiate appropriate solutions. ' Strong team building skills. ' Ability to effectively set priorities and meet commitments. ' Ability to work under pressure and within strict time frames. ' Comfortable interfacing at all levels of the organization. ' Appreciation of cultural diversity and sensitivity towards target population. Preferred: SCOPE INFORMATION Item Measure ' # Direct Reports ' 2-5 ' # Indirect Reports ' 1-10 ' Budgetary $ Responsibility - PHYSICAL REQUIREMENTS ' Must be able to operate a computer and a telephone. ' Manual dexterity to access filing systems. ' Must be able to conduct, facilitate, and actively participate in meetings. ' Periodic travel required - must be able to travel on common carrier]]> Fri, 27 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Nashville-Mgr-Appeals-&Grievance-QM-Corp-TN-37201/918834/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Mgr-Appeals-&Grievance-QM-Corp-TN-37201/918834/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12102
# Positions: 1
Location: US-TN-Nashville
Search Category: Human Resources
Type: Regular Full-Time (30+ hours)
Posted Date: 8/6/2010

More information about this job:

Overview:

Under direct supervision, perform administrative support to the Human Resources Department including processing/updating data into human resources information/computer system (HRIS) database, maintenance of confidential associate human resources files, and providing information to employees on matters pertaining to their personal employee information.

Responsibilities:

1. Provide general administrative support to the Human Resources team including processing/updating data into human resources information/computer system (HRIS) database, maintenance of confidential associate human resources files, and timely processing of recruitment, benefit, performance management, and other Human Resource-related paperwork. Verify that all forms are completed and all actions taken or requested are consistent with Amerigroup policies and procedures.
2. May assist with recruitment and/or generalist processes to include tasks related to sourcing/screening of resumes, scheduling interviews, exit interviews, offer packages, etc.
3. Facilitate New Hire Orientation sessions to review Company expectations, guidelines, as well as Corporate Policies and procedures
4. Coordinate pre-employment reference and criminal background checks.
5. Update and audit Position Control for designated area(s).
6. Create offer letters/memos for designated area(s).
7. Manage documentation and schedules for unemployment claims, appeals and hearings.

10. Generate ad hoc reports as needed.

11. Administer Educational Assistance including requests for reimbursement.

12. Process all referral, sign-on and retention bonus requests.

13. Assist with coordination of events such as associate recognition/appreciation, holiday events, recruiting events, etc.

14. Serve as back-up to other HR Coordinators/Specialists as required.

15. Provide training to new HR associates, which may involve travel.

16. Perform other duties as requested or assigned.

Qualifications:

Education

Required:

- High school diploma or equivalent

Preferred:

- Bachelor?s degree in related field or equivalent experience

Years and Type of Experience Required:

Required:

- Minimum 5 years of related experience

Specific Technical Skills

Required:

- Excellent computer skills and ability to use Microsoft Office Suite including Word, Excel and Outlook including:

- MS Word Mail Merge functionality
- Manipulation of Excel spreadsheets and understanding of formulas

Preferred:

- Experience working with PeopleSoft

Certifications or Licensures Preferred:

- PHR

Other:

Required:

- Excellent verbal and written communication skills, especially giving and receiving feedback.
- Strong organizational and analytical skills with high level of attention to detail.
- Provide high level of customer service.
- Strong interpersonal skills and ability to use tact and diplomacy.
- Ability to maintain confidentiality.
- Strong presentation skills.
- Dedicated team player, who demonstrates initiative.
- Proven problem solving skills.
- Must be flexible; able to handle multiple projects and changing priorities
- High energy and a positive can-do attitude.
- Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0

Budgetary $ Responsibility: N/A

PHYSICAL REQUIREMENTS:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.]]> Sun, 05 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Nashville-Sr-HR-Coordinator-Job-TN-37201/902194/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Sr-HR-Coordinator-Job-TN-37201/902194/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12089
# Positions: 1
Location: US-TN-Nashville
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/4/2010

More information about this job:

Overview:

Under the limited supervision, the Workforce Analyst analyzes real-time call volume patterns and various agent phone states using a Call Center Management System, and makes necessary skill changes to ensure calls are answered according to established service levels goals. The Workforce Analyst will effectively use a combination of workforce scheduling software and real-time queue management software to achieve service level goals.

Responsibilities:

Monitor real-time call volumes-to-phone associates using the queue management system and the agent schedule adherence application. Take proactive measures to meet call volume demands by adding or reprioritizing skill levels in associates? skill profiles in coordination with appropriate business partners.

Monitor daily service levels, productivity and adherence and alert management of negative performances. Recognize abnormal call variances, research and report findings to the Workforce Management Team.

Identify intervals where there is consistent overstaffing or understaffing and report inefficiencies to Workforce Management team.

Electronically broadcast service level statistical queue performances to senior management and explain events that resulted in outcomes and expound on actions taken to address queue activities, if needed.

Process associates? daily schedule exceptions in the scheduling applications to reconcile scheduled net staffing and associate adherence. Reconcile daily scheduling errors and adherence conflicts in the Scheduling and Adherence system. Generate attendance reports and assist in the assist in the preparation of the next day?s staffing reports.

Schedule ad hoc training and team meeting requests - including adjusting associates? breaks and lunches so that they do not conflict with other scheduled events or jeopardize service levels.

Enter and adjust schedules in the scheduling application, create and edit employee records, schedule meetings, training, process staffing transfers and terminations in related databases.

Process Time Off requests based on established criteria.

Keep Workforce Management systems and databases in synchronization so that when changes are made in one application, there are corresponding changes in supporting applications.

Other duties as assigned.

Qualifications:

Education

Required:

High school diploma or GED.

Preferred:

Associate?s degree in related discipline.

Years and Type of Experience Required:

Required:

Five years in a call center environment or equivalent combination of call center experience and higher education

Preferred:

Minimum of 2 years Call Center Intraday Queue Management experience (logistics or scheduling and planning).[RF1]

Managed Health Care experience.

Specific Technical Skills

Required:

Detail oriented with proven analytical ability, problem identification and escalation skills.

Supports and contributes towards continued process improvements.

Knowledge of call center metrics, agent behaviors and other factors that affect queue and adherence reporting.

Proven ability prioritizing and executing multiple tasks.

Preferred:

Knowledge of ACD/IVRs and call flows.

Experience with ACD reporting software-Call Management System (CMS)

Certifications or Licensures Preferred:

Six Sigma Certification

Member of Society of Workforce Planning Professionals (SWPP)

Other:

Required:

Ability to work in a virtual network, this includes interpersonal negotiations in addition to navigating within web based tools such as Impact 360 and SharePoint.

Proven ability prioritizing and executing multiple tasks.

Good verbal and written communication skills.

Strong customer service values.

Appreciation of cultural diversity and sensitivity towards target populations.

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 participate in meetings

Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.

Must be able and willing to work days, evenings or weekends (flexible shifts).

------------

[RF1]May want to have other type of experience as an acceptable requirement so that internal associates could qualify for this position.]]> Sun, 05 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Nashville-Workforce-Analyst-Job-TN-37201/895992/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Workforce-Analyst-Job-TN-37201/895992/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12048
# Positions: 1
Location: US-VA-Virginia Beach
Search Category: Call Center
Type: Regular Full-Time (30+ hours)
Posted Date: 7/29/2010

More information about this job:

Overview:

The Supervisor, Workforce Analysis is responsible for the daily oversight of the team responsible for analyzing real-time call volume patterns and various agent phone states, and making necessary skill changes to ensure established service level goals are attained. Provides guidance and technical support for Workforce Analysts and monitors performance to provide coaching and ensure quality and standards are met.

The Supervisor, Workforce Analysis will effectively use a combination of workforce scheduling software and real-time queue management software and will act as a liaison between the production line supervisors and the Workforce Analyst team to address intraday queue management and workforce schedule adherence issues affecting day-to-day operations tied to call queue performances.

Responsibilities:

1. Provide daily oversight and technical support to business unit and facilitate training on systems and processes for team. Monitor Workforce Analysts? queue management performances and coach analysts to meet performance goals by making agent skill change recommendations. Perform audit trails when researching and reconciling scheduling discrepancies and follow up with feedback to Workforce Analysts as warranted.
2. Monitor and manage real-time call volumes-to-phone associates using a queue management system and the agent schedule adherence application. Take proactive measures to meet call volume demands by adding or reprioritizing skill levels in associates? skill profiles within the queue management system in coordination with appropriate business partners.
3. Monitor daily service levels, productivity and adherence, alerting management of negative performances. Recognize abnormal call variances, research and report findings to the Workforce Management Team. Track and report forecasted verses actual call volume trends by market, campaign and site.
4. Electronically broadcast service level statistical queue performances to senior management and explain events that resulted in Service Level outcomes and expound on actions taken to address queue activities, if needed.
5. Based on current day trends of call statistics, make intraday projections of staffing level needs to meet Service Level Goals and allow for team meetings, coaching sessions, training and breaks. Initiate Voluntary Time Off or Overtime to address short-term changes in call volume patterns, or staffing challenges.
6. Achieve efficient utilization of staffing resources by reallocating available agents to queues that may be performing below established standards, thus smoothing out the workflow and balancing the workload. Identify intervals where there is consistent overstaffing or understaffing and report inefficiencies to team for permanent resolutions.
7. Maintain Agent Workforce Time Off Calendar module, ensuring appropriate staffing levels to meet call volume demands while allowing associates the opportunity to take Paid Accrued Leave (PAL). Process agent workforce time-off requests within established turn-around-times.
8. Participate in Workforce Management Scheduling application patch launches and other network upgrades and prepare for implementations. Following system enhancements perform testing to identify any glitches associated with the upgrades and then report results to Systems Support team.
9. Participate in Business Continuity and Recovery Plan (BCRP) by coordinating efforts with the Workforce Management Team and other key managers across all sites to ensure call volumes are handled to the maximum extent with limited resources, such as; when systems accessibility and significant agent staffing challenges occur.
10. Perform other duties as assigned/requested.

Qualifications:

Education Required:

- Bachelor?s degree in an Operations Management, Computers and Information Systems, Statistics or other business-related discipline, or equivalent experience in a call center environment.

Years and Type of Experience Required: Required:

- Minimum of 3 years Call Center Workforce Management (Logistics or Scheduling/Planning) experience.

Years and Type of Experience Preferred:

- Managed Health Care experience.

Specific Technical Skills Required:

- Experience routing calls to agents by adjusting skills or thresholds using queue management system.
- Solid knowledge and use of Microsoft Office including Excel & Word documents.
- Strong math skills and ability to perform statistical analysis
- Knowledge of Call Center metrics, agent behaviors and other factors that affect queue and adherence reporting.

Specific Technical Skills Preferred:

- Knowledge of ACD/IVRs and call flows.

Certifications or Licensures Preferred:

- Six Sigma Certification
- Member of Society of Workforce Planning Professionals (SWPP)

Other Required:

- Detail oriented with proven analytical ability, problem identification and escalation skills.
- Ability to work in a virtual network, this includes interpersonal negotiations in addition to navigating within web based tools such as Impact 360 and SharePoint.
- Proven ability prioritizing and executing multiple tasks.
- Excellent verbal and written communication skills.

SCOPE INFORMATION

# Direct Reports: 2-4

# Indirect Reports: 0

Budgetary $ Responsibility: 0

PHYSICAL REQUIREMENTS:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to participate in meetings
- Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
- Must be able and willing to work days, evenings or weekends (flexible shifts).]]> Mon, 30 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Virginia-Beach-Supervisor,-Workforce-Analysis-Job-VA-23450/890944/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Virginia-Beach-Supervisor,-Workforce-Analysis-Job-VA-23450/890944/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12304
# Positions: 1
Location: US-VA-Virginia Beach
Search Category: Legal
Type: Regular Full-Time (30+ hours)
Posted Date: 9/3/2010

More information about this job:

Overview:

The Senior Vice President, Business Development will lead and manage the work of the Business Development department to identify and prioritize Amerigroup business opportunities with state governments, and is responsible for the development and execution of business plans to win the state business.

The Business Development division includes the following functions: opportunity development and management, market and competitive analysis, RFP response. The SVP, Business Development will be able to shape his/her new organizational team to implement the Business Development strategic plan.

The Senior Vice President, Business Development will lead and manage the work of the Business Development department to identify and prioritize Amerigroup business opportunities with state governments, and is responsible for the development and execution of business plans to win the state business.

The Business Development division includes the following functions: opportunity development and management, market and competitive analysis, RFP response. The SVP, Business Development will be able to shape his/her new organizational team to implement the Business Development strategic plan

Responsibilities:

1. Lead, determine and drive the overall government markets strategy and tactical campaigns for Amerigroup growth nationally and for its newer product pipeline;
2. Develop, lead, and serve as primary point of accountability for the Company?s new growth expansion;
3. Develop and manage a pipeline of opportunities to achieve Company?s future financial goals;
4. Assess and prioritize new opportunities by establishing and fine-tuning company criteria and parameters;
5. Chair the Company?s Growth Committee with responsibility for analysis and go/no go recommendations/decisions;
6. Work closely with senior staff across the marketing group as well as with senior executives across the company, to support development of new business. This includes the CEOs of Amerigroup?s existing state and regional health plans, other senior operations and financial executives, and the state government relations team who can assist in identifying emerging trends within various state markets.
7. Direct the strategy and operation for all company RFPs, coordinate development with other relevant Amerigroup division staff and resources (including underwriting and pricing), and own the client relationship from designing and winning the contract until hand-off to new business implementation team;
8. Identify appropriate political strategies, and manage team development of preliminary product design, white papers, and sales preparation plans;
9. Create and lead the department?s work plan and market analyses team, including preparation of reports and studies, maintenance of data systems for market intelligence and competitor information, and identifying potential M&A candidates;
10. Build and maintain solid, ongoing relationships with relevant, key state decision makers in governors? offices, state legislatures, and executive agencies, and conduct regular meetings with these officials to help identify and develop new business opportunities, and shepherd new product proposals underway;
11. Lead Amerigroup participation at major meetings of such state officials as the governors, state legislators, Medicaid/Medicare directors, etc. in coordination with Amerigroup?s government relations team;
12. Present regular updates, sales reviews, and senior staff briefings as appropriate, and staff regular executive growth opportunity review sessions;
13. Create strong team spirit and morale with staff, and execute and manage such important internal responsibilities as staff reviews and compensation recommendations, organization budgets, etc., and
14. Partner with other Amerigroup executives on other projects as needed.

Qualifications:

Education:

Required: Bachelor?s degree required

Preferred: Masters degree

Years and Type of Experience Required::

Required: 14 years relevant work experience and at least 10 years of leadership/management experience.

Preferred: Previous work experience in a managed care setting

Specific Technical Skills:

Required:

- Executive knowledge of the business and financial environment of the health care market and state government.
- Proven track record in business development and finance.
- The ideal candidate will be a poised, high-energy individual who has experience in organizing campaigns, political and sales, as well as operations.
- Ability to and experience with anticipating and seizing new business opportunities, close high-end business deals, and short-circuit problems along the way.
- An understanding of campaigns·how to assemble teams, harness key information, work with state officials on a peer level, and create a favorable environment for selling Amerigroup and its products.
- A broad range of state government, business, provider, and patient group contacts.
- A thorough understanding of the procurement process in state governments.
- Significant experience in a Medicaid/managed care environment, state government, and/or business development organization.
- Initiative, creativity and strong sales abilities.
- Ability to relate on a peer level to the most senior state government decision-makers.
- Ability to drive decision-making processes within the organization and with senior management team.
- Ability to manage multiple priorities and projects simultaneously and produce high quality work under the pressure of deadlines.
- Appreciation of cultural diversity and sensitivity toward beneficiary population.
- Ability to work with many other resources with little supervision or direction.

Preferred:

- Direct experience in Medicaid/Medicare/managed care industry is preferred, but not required. Amerigroup staff subject matter experts will provide necessary technical program assistanc

Other:

Required:

- Excellent writing, communications, presentation, interpersonal, problem-solving, financial analysis, and organizational skills.
- High degree of business and personal ethics, and integrity.

SCOPE INFORMATION

Item

Measure

- # Direct Reports

3-7

- # Indirect Reports

Designated indirect reports for SME teams from all major departments.

- Budgetary $ Responsibility

Budgetary authority includes department budget as well as component parts of the annual AGP Development/ Implementation budget

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.]]> Sat, 04 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Virginia-Beach-SVP-Business-Development-Job-VA-23450/927199/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Virginia-Beach-SVP-Business-Development-Job-VA-23450/927199/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12245
# Positions: 1
Location: US-GA-Atlanta
Search Category: Sales & Marketing
Type: Regular Full-Time (30+ hours)
Posted Date: 8/27/2010

More information about this job:

Overview:

JOB SUMMARY: Responsible for establishing/maintaining/monitoring activities that will with regulators and elected officials that will impact Amerigroup's business while maintaining an understanding of Amerigroup's mission and values. Will work closely with the VP, Government Relations to formulate and execute regulatory and legislative strategy.

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Monitor and coordinate responses to state or Federal legislation or anticipated legislative initiatives and regulatory changes. 2. Work with Operations, Business Development, and Government Relations to establish and implement strategies to bring new products or expansions of current products to market areas 3. Work with regulators on reporting and other regulatory matters as appropriate. 4. Work with VP, Government Relations, CEO/COO and market staff to align Amerigroup with relevant community-based organizations and influential individuals in the market. 5. Organizing meetings at the state and regional levels that showcase Amerigroup programs/products and services and highlight the mission and values of Amerigroup. 6. Monitor all rule making at HHSC, TDI or any other agency where there is a possible opportunity or threat to Amerigroup business. When appropriate, lead a team to bring issues related to rule-making to resolution, including working with legal to draft responses and submit them. 7. Monitor all hearings related to relevant legislative committees. Work with VP, Government Relations and other key leader to ensure public hearings are as positive as possible for Amerigroup. 8. Continually monitor market databases and product review to analyze select opportunities. 9. Other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: ' Bachelor's degree Preferred: ' Advanced degree preferred. Years and Type of Experience Required: Required: ' Minimum of 10 years experience in government relations, marketing, public relations or related field and at least 5 years of leadership/management experience. Preferred ' Previous HMO/managed care industry experience preferred. ' Previous Senior Level Role in a Government Relations field. ' Experience in a Medicaid regulatory environment, state legislature or related field. Specific Technical Skills Required: ' Proficient with MS Office (Word, Excel, PowerPoint), graphics and spreadsheet applications Certifications or Licensures Required: ' None Other: Required: ' Excellent writing, communications, presentation, interpersonal, problem-solving, analytical and organizational skills. ' Excellent understanding of word processing, graphics and spreadsheet applications. ' Able to handle multiple priorities. ' Able to work well and produce high quality results under the pressure of deadlines. ' Able to work with many other resources with little supervision or direction. ' Previous HMO/managed care industry experience preferred. ' Appreciation of cultural diversity and sensitivity towards target population. SCOPE INFORMATION # Direct Reports: # 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. ' Standing and/or sitting for long periods of time. ' Data entry using repetitive motion. ' Must be able to operate a motor vehicle (in conjunction w/travel)]]> Sat, 28 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Atlanta-AVP-Govt-Relations-GA-30301/920172/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Atlanta-AVP-Govt-Relations-GA-30301/920172/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12315
# Positions: 1
Location: US-NJ-Edison
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 9/8/2010

More information about this job:

Overview:

The Provider Relations Analyst supports the Provider Relations Dept. by managing the regulatory, contractual, and strategic reporting activities needed to make appropriate business decisions regarding the provider and hospital network, provider relations activities, and strategic planning.

In addition, the Provider Relations Analyst will spend approximately 50% of his/her time in the field meeting with network hospital and ancillary vendors to solidify relationships and orient them on Amerigroup?s policies and processes.

Responsibilities:

1. Utilizes knowledge of databases, information systems, statistical tools and analytical principles to analyze outcomes that support strategies for managing health plan network performance.
2. Produces, analyzes and maintains reports used to measure, monitor and manage network deficiencies, as well as other financial analysis.
3. Responds to state network inquiries, and analyzes state reports and information for accuracy and completeness.
4. Compiles and reports on provider data in Salesforce for productivity metrics as well as network gaps.
5. Acts as liaison with corporate provider relations to monitor and report on the status of physician, hospital and ancillary rates and contract information.
6. Research and report on contractual changes and analyze their impact to the health plan.
7. Create, maintain, and reports on the following information: ICR Medicaid, POC comparison, rate tracking by proposal, budget spending, credentialing status, etc.
8. Assist in the development of department policies and procedures. Report on any updates.
9. Meets with key contract negotiators and COOs at network hospitals and large ancillary vendors to identify, investigate and resolve root cause problems to reduce billing complaints and appeals.
10.
Educates hospital staff and vendors regarding AMERIGROUP policies and procedures, authorizations, Quick Reference Guides and ensure hospital staff is accessing Amerigroup?s IVR and internet-based functions while ensuring electronic billing.

11.
Become Amerigroup UAT certified for UAT testing of hospital and ancillary applications.

12.
Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:

- Bachelor?s Degree or minimum of 3 years health care or other comparable experience in lieu of degree

Preferred:

- Degree and/or experience in finance, business, healthcare administration, or other related subjects

Years and Type of Experience Required:

Required:

- Minimum of 3 yrs. experience in insurance, healthcare, or other related field.

Preferred:

- Experience in Medicaid/Medicare network activities
- Field experience and/or presentation experience a plus

Specific Technical Skills

Required:

- Knowledge of MS Office Suite (Word and Excel)

Preferred:

- Experience working with databases.
- Experience with report generation.

Certifications or Licensures

Required:

- Must have a valid driver?s license, current auto insurance and access to a motor vehicle

Other:

- Ability to work in a team environment as well as independently.
- Excellent organizational and time management skills.
- Excellent communication skills for presentation of information to individuals and groups.
- Self-starter able to work with minimal oversight
- Able to work under pressure and meet deadlines.]]> Thu, 09 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Edison-Provider-Relations-Analyst-Job-NJ-08818/929866/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Edison-Provider-Relations-Analyst-Job-NJ-08818/929866/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12154
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Sales & Marketing
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

The Community Liaison works independently to manage the implementation and ongoing development of brand, retention and community strategies. Responsible for professionally representing AMERIGROUP to advocacy groups, organizations, providers and other diverse audiences and populations in a variety of settings, events, and venues. Develops and fosters partnerships and awareness in the community and state by educating and servicing the population as the face of Amerigroup to include: organizational board participation, outreach to existing and potential members, health education and promotion.

Responsibilities:

1. Manages community outreach initiatives to include health information that promotes healthy lifestyles, and information that provides culturally and linguistically appropriate health or nutritional education.

2. Manages member outreach initiatives (FL Plan) to provide information and guidance about social assistance programs

3. Represents AMERIGROUP by participating on Boards and/or committees of significant community organizations to increase awareness of health plan.

4. Develops communication strategies to increase awareness of health plan benefits and services, member retention, and community services that support the population, such as grant proposal, media placement, and marketing materials.

5. Facilitates collaboration of individuals, groups, social service agencies and other community organizations in educational and outreach activities, thus developing interagency groups supporting needs of population.

6. Conducts presentations and performs other activities in an effort to increase health plan awareness and maintains and/or establishes positive relationships with providers, community and faith based organizations.

7. Builds relationships with key providers in the market who have the ability to serve the underserved populations, building the capacity to serve such population.

8. Identifies opportunities to coordinate special events and presentations. Works with team to schedule, set-up, staff and break down events.

9. Participates in product development and enhancement.

10. May develops population surveys and develops specific programming related to survey results (FL Plan).

11. Interviews organizations and/or members to produce success stories/AMERIGROUP Real Stories.

12. Maintains regional marketing analysis to support ongoing evaluation of AMERIGROUP strategy.

13. Promotes company's brand throughout all activities in assigned region.

14. Identifies and collects educational material on community networks and advocacy groups to develop resources so that AMERIGROUP is the subject matter expert for the communities we serve.

15. Complies with state mandated rules, regulations and contractual requirements as well as AMERIGROUP policies and procedures.

16. Other duties as assigned

Qualifications:

Education

Required:

BA/BS degree in healthcare/marketing or equivalent experience.

Years and Type of Experience Required:

Required:

5 years of successful community outreach experience focused on targeted audiences; or 3 years of managed care experience interacting with and providing support to the provider relations network. For Fl Plan only additional 2 years experience working with the SSI/ABD population

Deaf HOH and Blind population

Experience in event planning

Comprehensive understanding of the Medicaid market

Preferred:

Previous experience in outreach to members to include resolution of issues

Previous involvement on boards and/or committees

Successful record of community volunteer work

Managed care experience interacting with and providing support to the provider relations network; including but not limited to responding to inquiries from providers to clarify issues related to member benefits, claim resolution appeal status, provider recruitment and authorization or referral information.

Specific Technical Skills

Required:

Bi-lingual (English/Spanish) (For NJ Plan Only)

MS Office Suite ' Word, Excel, PowerPoint, Outlook and Internet research

Experience with the input and manipulation of data in windows-based applications

Preferred:

Knowledge of proper grant proposals preparationsalesforce.com; demonstrated aptitude to learn technology

Knowledge and understanding of financial terminology, and ability to read and interpret financial reports.

Proficient in American Sign Language (able to serve as an interpreter)

Bi-lingual (English/Spanish)

Certifications or Licensures

Required:

Valid driver's license and have access to an insured motor vehicle for business use.

Other:

Required:

Ability to present products, programs, and services to groups, organizations or individuals to key decision makers and senior level leadership

Social networking and internet marketing communication experience

Displays a high level of initiative. Dynamic individual willing to embrace concepts and develop appropriate programs.

Able to communicate publicly - clearly present information through speaking and/or writing.

Must be able to work non-traditional hours or as needed

evenings and/or weekends

Ability to work independently or as part of a team;

Self-motivated; work with limited supervision.

Able to drive daily within assigned territory; travel within the state for special events, meetings or conferences.

Values and respects the diversity of backgrounds and cultures represented by team members and the target population.

Ability to manage multiple projects and priorities simultaneously (multi-task oriented)

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]]> Sat, 14 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Grand-Prairie-Community-Liaison-Plan-Job-TX-75050/908014/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Community-Liaison-Plan-Job-TX-75050/908014/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12181
# Positions: 1
Location: US-VA-Merrifield
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 8/18/2010

More information about this job:

Overview:

JOB SUMMARY: Responsible for member retention by investigating and leading the resolution of member complaints. Serve as a liaison/mediator between member, the provider and Plan, Provide education to the member on Medicaid Managed Care and their benefits with AMERIGROUP, informing and ensuring that members are aware of their rights and responsibilities, the complaint process, and health education activities available in the community. Support member outreach activities.

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Investigate, resolve, and document member complaints in accordance with AMERIGROUP policies and State requirements. 2. Conduct out-of office / home visits with members to educate and advise on AMERIGROUP programs, policy, and benefits as appropriate. 3. Investigate and resolve issues regarding members with non-compliant, behavioral, and abusive conduct identified by providers. Work with law enforcement officials as appropriate. 4. Conduct member interviews to ensure that members are informed of their rights and responsibilities. 5. Assist with member education related to prevention, outreach and education programs. 6. Identify members to participate on Plan committees. 7. Assist member as needed, including locating a PCP, obtaining medical records, obtaining transportation, and completing required forms. Resolution and coordination in barriers to care needs. 8. Assist in the preparation for a Grievance Panel, assuring member participation and explaining the process to the member. 9. Review complaint reports for accuracy and completeness and ensure required reports meet timely filing requirements. 10. Participate on the weekly complaint review committee as appropriate. 11. Assist in the maintenance of the complaint database. 12. Prepare additional reports and presentations as needed to support community relations, Provider Services and member education activities. 13. Attend community events as appropriate. 14. Track, trend, and report quality and access complaints by provider. Coordinate with provider relations for follow-up of issues identified. 15. Act as member advocate with providers, CBO's, and AMERIGROUP associates as indicated. 16. Serve as liaison with state hot line staff and internal compliance personnel. 17. Work with other AMERIGROUP departments and with physicians to resolve member issues. 18. Establish and maintain working relationships with member advocacy groups. 19. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: · Two-year degree in a related field or. 3 ' 5 years experience in a social or health related service-oriented industry Years and Type of Experience Required: Required: · 3 ' 5 years experience in a social or health related service-oriented industry · Experience with complaint/grievance processes Preferred: · Previous experience in a Medicaid Managed Care Health Plan · Successful record of community volunteer work · Previous experience in outreach to members to include resolution of issues Specific Technical Skills Required: · Excellent interpersonal, organizational, problem solving, multitasking, analytical and communication skills · Excellent Customer Service skills · Appreciation of cultural diversity and sensitivity towards target population · Professional telephone etiquette. · Presentation skills · Ability to work calmly and effectively under adverse conditions · Computer keyboard and word processing proficiency Preferred: · Bi-lingual preferred · Strong mediation skills Certifications or Licensure Required: · Must possess a valid driver's license and required insurance Preferred: Other Required: · Ability to work evenings and weekends as needed Preferred: · Established working relationships with Community Based Organizations SCOPE INFORMATION ' # Direct Reports ' # Indirect Reports ' Budgetary $ Responsibility PHYSICAL REQUIREMENTS ' Must be able to operate a computer ' Must be able to operate a telephone ' Local travel required - must be able to travel locally to physician offices and members homes ' Must be able to communicate verbally ' Must be able to tolerate standing and sitting for long periods of time ' Must be able to operate a motor vehicl]]> Thu, 19 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Merrifield-QM-Membr-Advocate-VA-22081/911674/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Merrifield-QM-Membr-Advocate-VA-22081/911674/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11978
# Positions: 1
Location: US-VA-Virginia Beach
Search Category: Sales & Marketing
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

Responsible for developing and executing marketing, member, and provider communication strategies, plans, and collateral to support membership and provider acquisition and retention. Manages writing and art teams. With department leader(s), provides overall creative direction for all communications to ensure consistent brand, quality, tone, manner, and message.

Responsibilities:

1. Oversee the development, coordination, and implementation of communications plans with business units and health plans throughout AMERIGROUP.

2. Assist health plans in the development of specific communications and creative approaches to reaching prospective members, existing members, prospective providers, and existing providers.

3. Work closely with Marketing Services department, Sales and Member Advocacy department, and health plan leaders on marketing direction, creative execution and strategies to ensure consistent delivery of messages in all marketplaces.

4. Work closely with Marketing Services and other AMERIGROUP department staff to develop value proposition(s) for new products. Develops specific marketing and communications plans for these new products as needed.

5. Assist in the development/evolution and implementation of the AMERIGROUP brand and overarching marketing and positioning strategy.

6. Work with all products (Medicaid, SSI, Medicare) to ensure consistency among communications efficiency in execution, and quality of finished products.

7. Identify need for, organize and direct training for Marketing Services staff.

8. Ensure staff and deliverable adherence to AMERIGROUP policies and procedures and compliance with state and municipal laws, rules and guidelines for marketing.

9. Develop processes, policies, and systems to improve workflow, customer service, transparency, quality, and efficiency.

10. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required: Bachelor's degree in Marketing, Communications, or related area

Preferred: Master's degree in Business, Communications, or related area

Years and Type of Experience Required:

Required: 10 years relevant work experience (direct experience and proven results in communications, marketing or advertising) and at least 5 years of leadership/management experience.

Preferred: Experience working in a management capacity for a managed care organization, ideally with specific experience in Medicaid managed care

Specific Technical Skills

Required: Proficient in Microsoft Word, PowerPoint and Outlook; working knowledge of Excel, Project, Visio, and SharePoint. Excellent command of English language and working knowledge of Associated Press Style guidelines.

Other

Required:

- Ability to think creatively and strategically.
- Ability to translate strategy into practical and specific tactics that produce results.
- Knowledge of best practices in communications and/or advertising/marketing.
- Ability to develop and manage relationships with advertising agencies and efficiently manage communications campaigns.
- Excellent verbal and written communication skills.
- Ability to work well at all levels of the organization.
- Appreciation of cultural diversity and sensitivity towards target population.

Preferred:

- Good analytical and financial skills.

SCOPE INFORMATION

Item Measure

- # Direct Reports 3 - 4
- # Indirect Reports 10
- Budgetary $ Responsibility $1 million
- Assists Marketing Services department leadership in managing budget of over $3 million.

PHYSICAL REQUIREMENTS

- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to travel by common carrier and to adhere to AMERIGROUP's travel policies

Event9112010]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Virginia-Beach-AVP-Marketing-Communications-Job-VA-23450/886604/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Virginia-Beach-AVP-Marketing-Communications-Job-VA-23450/886604/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12057
# Positions: 1
Location: US-VA-Virginia Beach
Search Category: Legal
Type: Regular Full-Time (30+ hours)
Posted Date: 7/30/2010

More information about this job:

Overview:

The position is responsible for the regulatory compliance activities of AMERIGROUP's Medicare Advantage Special Needs Plan (SNP) and Part D Prescription Drug (PD) product offerings The Compliance Analyst focuses on AMERIGROUP and its delegated vendor's, first tier, and downstream related entities compliance with the regulatory/contractual obligations of the Centers for Medicare and Medicaid Services (CMS) and multiple state regulatory bodies, as well as oversight of the SNP and PD product requirements and deliverables.

Responsibilities:

Support the oversight of the federal and state regulatory compliance programs and activities for AMERIGROUP's SNP and PD products.

Provide management with information for strategic planning. AMERIGROUP liaison with CMS and applicable state agencies, serving as an account manager.

Maintain productive working relationships with key regulators charged with AMERIGROUP contract administration that leads to a collaboration benefiting company operations and activity.

Subject matter expert on Medicare Advantage and Part D requirements and programs.

Assess, communicate and ensure associate understanding of federal regulations, legislation and CMS Operational Manuals and Memorandums that impact business activity and operations.

Maintain resource tools identifying SNP and PD requirements for internal education, and compliance assessments.

Participate in AMERIGROUP and vendor preparations for multiple SNP and PD performance assessments, CMS audits, and Program Integrity Audits.

Assist in preparing AMERIGROUP and vendor operational leads for targeted audit activity.

Coordinate and organize desk review submissions and on-site audit materials.

Participate in on-site assessment and audit activity.

Facilitate development of corrective action plans (CAPs) and oversee CAP implementation.

Interact with audit and enforcement agencies to correct deficiencies and minimize CMS administrative actions and sanction activity.

Manage submissions of regulatory deliverables and monitor CMS management reports.

Responsible for the review and submission of CMS Part C and D reporting to ensure compliance with CMS requirements.

Manage regulatory filings and approvals of marketing/advertising materials, member correspondence and outreach programs through CMS HPMS system.

Review collateral materials via Collateral Material Approval Process

Negotiate approvals by CMS and state agency liaisons.

Participate in SNP and PD product expansion and new market activities via project management of regulatory document preparation, submission and federal/state approvals.

Define regulatory requirements and maintain project plan and document tracking system.

Identify/attain agreement on business owner accountability for deliverables.

Guide project team members to ensure project deliverables are met, disconnects identified and resolutions achieved.

Department implementation lead.

Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education:

Required: High School Diploma with 3 years relevant work experience

Preferred : Bachelor?s Degree

Years and Type of Experience Required:

Required:

- Minimum of 3 years experience working in regulatory operations of a Medicare Advantage (Medicare+Choice) plan
- Knowledge of federal HMO and Medicare Managed care regulations

Specific Technical Skills

Required: Intermediate level Microsoft Office Suite skills. Specifically Word and Excel.

Other

Required:

- Strong analytical and organizational skills.
- Strong verbal and written communication skills.
- Ability to analyze, interpret, and summarize contracts, regulations, policies/procedures, reports and legal documents.
- Ability to respond to questions/concern from internal customers and regulatory agencies present company position in understandable and unambiguous manner.
- Ability to identify root cause, recommend options and implement/negotiate appropriate solutions.
- Ability to effectively set priorities and meet commitments.
- Ability to work under pressure and within strict time frames.
- Comfortable interfacing at all levels of the organization.
- Appreciation of cultural diversity and sensitivity towards target population.

PHYSICAL REQUIREMENTS

- Must be able to operate a computer and a telephone.
- Must be able to access/operate filing systems.
- Must be able to conduct, facilitate, and actively participate in meetings.
- Periodic travel required - must be able to travel on common carrier.]]> Tue, 31 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Virginia-Beach-Compliance-Analyst-Medicare-Job-VA-23450/892052/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Virginia-Beach-Compliance-Analyst-Medicare-Job-VA-23450/892052/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12314
# Positions: 1
Location: US-FL-Boca Raton
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 9/8/2010

More information about this job:

Overview:

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

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force). 2. Ensures that provider relationships with the Plan are positive and productive for both parties. 3. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. . Works with Provider's staff and AMERIGROUP staff (local and/or corporate) to resolve the issue and monitor recurrence. 4. Assists with training and mentoring of the Provider Relations Representatives as needed to ensure departmental success and effective team work. In the absence of management, acts as the lead or senior associate in the department or for the assigned team. 5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner. 6. Analyzes provider network for adequacy in addressing members' medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist. 7. Creates and maintains information required to support the network development process. 8. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures. 9. Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures. 10. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames. 11. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities. 12. Performs other duties and special projects as assigned

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: ' BA/BS degree or equivalent experience Preferred: Years and Type of Experience Required: Required: ' 5+ years of managed care experience, preferably in a Medicaid environment Preferred: Specific Technical Skills Required: ' Proficiency with Microsoft computer applications including Outlook, Word, and Excel. ' Claims experience/knowledge of medical coding ' Strong telephonic and customer service skills. ' Effective presentation skills. Preferred: ' Experience using Sales force CRM ' Experience using Facets. Certifications or Licensures Required: ' Valid Drivers License Preferred: ' Other: Required: ' Excellent verbal and written communication skills. ' Detail-oriented. ' Ability to handle multiple tasks in a fast-paced environment. ' Must be service oriented and able to identify and resolve problems. ' Appreciation of cultural diversity and sensitivity toward target population. ' Preferred: ' SCOPE INFORMATION # Direct Reports: # Indirect Reports: Budgetary $ Responsibility: PHYSICAL REQUIREMENTS ' Must be able to operate a computer, telephone and fax machine. ' Must be able to travel locally. ' Must be able to operate a motor vehicle. ' Must be able to conduct and participate in meetings]]> Thu, 09 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Boca-Raton-Provider-Relations-Rep-II-Stuart,-Florida-Job-FL-33427/929865/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Boca-Raton-Provider-Relations-Rep-II-Stuart,-Florida-Job-FL-33427/929865/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12037
# Positions: 1
Location: US-FL-Miami Lakes
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 7/28/2010

More information about this job:

Overview:

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

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force). 2. Ensures that provider relationships with the Plan are positive and productive for both parties. 3. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. . Works with Provider's staff and AMERIGROUP staff (local and/or corporate) to resolve the issue and monitor recurrence. 4. Assists with training and mentoring of the Provider Relations Representatives as needed to ensure departmental success and effective team work. In the absence of management, acts as the lead or senior associate in the department or for the assigned team. 5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner. 6. Analyzes provider network for adequacy in addressing members' medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist. 7. Creates and maintains information required to support the network development process. 8. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures. 9. Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures. 10. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames. 11. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities. 12. Performs other duties and special projects as assigned

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: ' BA/BS degree or equivalent experience Preferred: Years and Type of Experience Required: Required: ' 5+ years of managed care experience, preferably in a Medicaid environment Preferred: Specific Technical Skills Required: ' Proficiency with Microsoft computer applications including Outlook, Word, and Excel. ' Claims experience/knowledge of medical coding ' Strong telephonic and customer service skills. ' Effective presentation skills. Preferred: ' Experience using Sales force CRM ' Experience using Facets. Certifications or Licensures Required: ' Valid Drivers License Preferred: ' Other: Required: ' Excellent verbal and written communication skills. ' Detail-oriented. ' Ability to handle multiple tasks in a fast-paced environment. ' Must be service oriented and able to identify and resolve problems. ' Appreciation of cultural diversity and sensitivity toward target population. ' Preferred: ' SCOPE INFORMATION # Direct Reports: # Indirect Reports: Budgetary $ Responsibility: PHYSICAL REQUIREMENTS ' Must be able to operate a computer, telephone and fax machine. ' Must be able to travel locally. ' Must be able to operate a motor vehicle. ' Must be able to conduct and participate in meetings]]> Sat, 28 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Miami-Lakes-Provider-Relations-Rep-II-Job-FL-33014/889748/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Miami-Lakes-Provider-Relations-Rep-II-Job-FL-33014/889748/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12055
# Positions: 1
Location: US-MD-Hanover
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 7/30/2010

More information about this job:

Overview:

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

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force). 2. Ensures that provider relationships with the Plan are positive and productive for both parties. 3. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. . Works with Provider's staff and AMERIGROUP staff (local and/or corporate) to resolve the issue and monitor recurrence. 4. Assists with training and mentoring of the Provider Relations Representatives as needed to ensure departmental success and effective team work. In the absence of management, acts as the lead or senior associate in the department or for the assigned team. 5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner. 6. Analyzes provider network for adequacy in addressing members' medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist. 7. Creates and maintains information required to support the network development process. 8. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures. 9. Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures. 10. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames. 11. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities. 12. Performs other duties and special projects as assigned

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: ' BA/BS degree or equivalent experience Preferred: Years and Type of Experience Required: Required: ' 5+ years of managed care experience, preferably in a Medicaid environment Preferred: Specific Technical Skills Required: ' Proficiency with Microsoft computer applications including Outlook, Word, and Excel. ' Claims experience/knowledge of medical coding ' Strong telephonic and customer service skills. ' Effective presentation skills. Preferred: ' Experience using Sales force CRM ' Experience using Facets. Certifications or Licensures Required: ' Valid Drivers License Preferred: ' Other: Required: ' Excellent verbal and written communication skills. ' Detail-oriented. ' Ability to handle multiple tasks in a fast-paced environment. ' Must be service oriented and able to identify and resolve problems. ' Appreciation of cultural diversity and sensitivity toward target population. ' Preferred: ' SCOPE INFORMATION # Direct Reports: # Indirect Reports: Budgetary $ Responsibility: PHYSICAL REQUIREMENTS ' Must be able to operate a computer, telephone and fax machine. ' Must be able to travel locally. ' Must be able to operate a motor vehicle. ' Must be able to conduct and participate in meetings]]> Tue, 31 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Hanover-Provider-Relations-Rep-II-Job-MD-21075/892050/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Hanover-Provider-Relations-Rep-II-Job-MD-21075/892050/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS