http://www.amerigroup-jobs.com/feeds/jobs-health-policy-analyst-AMERIGROUP/ Custom RSS Feed for jobs-health-policy-analyst-AMERIGROUP Thu, 23 May 2013 04:40:44 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/feeds/jobs-health-policy-analyst-AMERIGROUP/ 720
Job ID 2013-22785 # Positions 1
Location US-TX-Houston
Search Category Medical Director
Type Regular Full-Time (30+ hours) Posted Date 5/7/2013
Additional Locations ..

More information about this job:
Summary:

AMERIGROUP CORPORATION

MEDICAL DIRECTOR BEHAVORIAL HEALTH Houston

Amerigroup is a Fortune 500 company serving approximately 2 million members in 14 states. Nationwide, we serve one out of every 35 Medicaid recipients and one out of every 25 kids covered by CHIP.

We improve access to quality health care for our members while lowering costs for taxpayers. We coordinate services for individuals in publicly funded health care programs.

Amerigroup accepts all eligible people regardless of age, sex, race or disability.

Our product offerings do not utilize any individual underwriting nor deny coverage due to pre-existing medical conditions. Amerigroup is dedicated to offering real solutions that improve health care access and quality for its members, while proactively working to reduce the overall cost of care to taxpayers.

JOB SUMMARY

Oversees all behavioral health care for AMERIGROUP products and services in Houston. Oversees the health care needs of the membership and serves as the principal behavioral health manager and policy advisor to the company and health plan CEO or COO. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with behavioral health management such as medical management, provider relations, member services, benefits and claims management, etc. Assists in short and long range program planning, total quality management (quality improvement) and external relationships. Works with Corporate Health and Medical Affairs for support, assistance and direction in overall behavioral health management effectiveness. Reports all issues of clinical quality management to the health plan CEO, COO, the Board and the Chief Medical Officer (CMO) of AMERIGROUP Corporation. Collaborates with the CMO, the National Medical Director of Behavioral Health and other health plan medical directors on national medical policies and carries out national medical policies at the health plan in collaboration with the health plan CEO or COO

Responsibilities:

1. Assists in managing medical costs and assuring appropriate health care delivery for Amerigroup health plans, products and services.

2. Provides guidance, support and leadership for utilization management activities.

3. Supports Medical Director(s) in all aspects of utilization, quality and network management.

4. Provides support to nurses and clinical leaders in pre-authorization, concurrent and retrospective review decisions, case management and disease management decisions.

5. Assists Medical Directors and/or National Medical Directors with medical policy; participates in policy review, reviews trends and makes recommendations; may plan, organize and/or direct medical services programs, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.

6. Assists in the design and implementation of corrective action plans to address issues and improve plan and network managed care performance.

7. Supports URAC, AHCA and NCQA qualification activities. Prepare for site visits and responds to accrediting and regulatory agency feedback.

8. Participates in risk management, claims adjudication, utilization management, catastrophic case review, education and outreach programs, HEDIS reporting, credentialing, peer to peer review, appeals review, denials, etc.

9. Participates in the development of strategic planning for existing and expanding business. Recommends changes in program content in concurrence with changing markets and technologies.

10. Other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:

Medical Doctor with specialization and board certification in Psychiatry. - Continuing education to remain current in behavioral health and management areas. - Any equivalent combination of education and experience. Years and Type of Experience Required: Required: - Five years of clinical experience in the practice of medicine, two of which have been in medical and/or health administration. - Three to five years of management and /or clinical experience in a managed care environment. Certifications or Licensure Required: •Board Certified in Psychiatry. - Must be licensed in the state of Texas as a Doctor of Medicine or be able to achieve such licensure upon hire- Active license to practice medicine without restriction issued by the State Board of Licensure or the State Board of Examiners. Preferred: - Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management desired but not required. Other Required: - Management skills to meet the organizational goals. - Must possess excellent communications skills to interface with providers, staff, and management. - Knowledge of behavioral health, quality improvement and UM practices in a managed care environment. - Knowledge of regulatory and accreditation agencies and requirements. - Able to manage multiple priorities and deadlines in an expedient and decisive manner. - Able to manage difficult peer situations arising from medical care review. - Appreciation of cultural diversity and sensitivity towards target population. PHYSICAL REQUIREMENTS: - Must be able to operate a computer. - Must be able to operate a telephone. - Must be able to travel on common carriers and to adhere to AMERIGROUP’s travel policies. - Must be able to operate a motor vehicle. - Must be able to conduct and participate in meetings

Preferred:
- Board Certification in Addictionology or substantial clinical experience in substance use disorders OR Child Psychiarty
- Masters in Public Health, MBA or MA.
- Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management

Language Skills

Required:
- English

Functional Competencies
- Think creatively, Innovative
- Understanding of financial and business acumen
- Collaborative team player; active listening skills
- Excellent verbal and written communication skills and ability to build and sustain strong working relationships
- Organizational skills and demonstrated ability to multitask and execute
- Strong people leadership and influencing skills
- Strong project management skills; ability to drive programs and lead change
- Knowledge of medical, quality improvement and utilization management practices in a managed care environment
- Knowledge of regulatory and accreditation agencies and requirements
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.
- Ability to read, comprehend and interpret complex information and trends to provide accurate and appropriate information to business partners and/or customers.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.

SCOPE INFORMATION

# Direct Reports: As assigned

# Indirect Reports: As assigned

Budgetary $ Responsibility: As assigned

PHYSICAL REQUIREMENTS

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

CB1

ermEL
]]>Tue, 07 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Medical-Director-Behavorial-Health-Job-TX-77001/2585343/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Medical-Director-Behavorial-Health-Job-TX-77001/2585343/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-20924 # Positions 1
Location US-KS-Overland Park
Search Category Medical Director
Type Regular Part-Time (20-29 hours) Posted Date 10/12/2012
Additional Locations ..

More information about this job:
Summary:

Amerigroup is a Fortune 500 company serving approximately 2 million members in 14 states. Nationwide, we serve one out of every 35 Medicaid recipients and one out of every 25 kids covered by CHIP.

We improve access to quality health care for our members while lowering costs for taxpayers. We coordinate services for individuals in publicly funded health care programs.

Amerigroup accepts all eligible people regardless of age, sex, race or disability.

Our product offerings do not utilize any individual underwriting nor deny coverage due to pre-existing medical conditions. Amerigroup is dedicated to offering real solutions that improve health care access and quality for its members, while proactively working to reduce the overall cost of care to taxpayers.

Responsibilities:

Provides support and leadership around behavioral health care for AMERIGROUP products and services in Kansas.. Provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with behavioral health management such as medical management, provider relations, member services, benefits and claims management, etc. Assists in short and long range program planning, total quality management (quality improvement) and external relationships. Works with Corporate Health and Medical Affairs for support, assistance and direction in overall behavioral health management effectiveness.. Collaborates with the CMO, the National Medical Director of Behavioral Health and other health plan medical directors on national medical policies and carries out national medical policies at the health plan in collaboration with the health plan CEO or COO.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- MD or DO, with board certification in area of specialty.

Preferred:
- Masters in Public Health, MBA or MA.

Years and Type of Experience Required:

Required:
- Minimum of five years clinical experience with at least two years in medical management/health administration in a managed care environment.

Certifications or Licensures

Required:
- Active license to practice medicine without restriction issued by the State Board of Licensure or the State Board of Osteopathic Examiners. Certified in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS).

Preferred:
- Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management

Language Skills

Required:
- English

Functional Competencies
- Think creatively, Innovative
- Understanding of financial and business acumen
- Collaborative team player; active listening skills
- Excellent verbal and written communication skills and ability to build and sustain strong working relationships
- Organizational skills and demonstrated ability to multitask and execute
- Strong people leadership and influencing skills
- Strong project management skills; ability to drive programs and lead change
- Knowledge of medical, quality improvement and utilization management practices in a managed care environment
- Knowledge of regulatory and accreditation agencies and requirements
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.
- Ability to read, comprehend and interpret complex information and trends to provide accurate and appropriate information to business partners and/or customers.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.

SCOPE INFORMATION

# Direct Reports: As assigned

# Indirect Reports: As assigned

Budgetary $ Responsibility: As assigned

PHYSICAL REQUIREMENTS

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

HEC:DW

ermEL
]]>Sun, 28 Apr 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-Medical-Director-Behavorial-Health-Part-Time-Job-KS-66062/2211141/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-Medical-Director-Behavorial-Health-Part-Time-Job-KS-66062/2211141/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22843 # Positions 1
Location US-VA-Virginia Beach
Search Category Communications
Type Regular Full-Time (30+ hours) Posted Date 5/14/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for ensuring the overall quality of designated Proposal Management projects with elements such as researching, writing and organizing documents in support of Amerigroup’s business development and proposal efforts. Responsible for on-boarding, training and managing associate and consultant writers, editors and compliance reviewers and copy editors. In this role, tactical execution is necessary to prepare well-written responses/documents that comply with Requests For Proposal (RFPs) and Requests for Information (RFIs) from start to finish, working with subject matter experts (SMEs) to gather information and provide high-quality proposal responses. Serve as a leader within the department (to other writers and production team members) and outside the department to executives, associates and external consultants and vendors.

Responsibilities:

1. Responsible for developing, creating, reviewing, editing and managing designated RFPs. Develop training materials to efficiently educate writers on the Amerigroup process.

2. Create or refine proposals, an ability to cite proposal portions that require clarification and supporting proof/data points, verifying and amending content/data gaps, confirming strategy/product alignment.

3. Supervise the processes and procedures of designated RFPs. Schedule deliverables and ensure that consultants are available in the needed timeframes.

4. Responsible for the on-boarding of new consultant writers and editors to include pre-screen interviews, assessing strengths and areas of writing expertise and asissitng new consultants through the onboarding process.

5. Coordinate and schedule (including working with appropriate presenters) training sessions as needed for new associate and/or consultant training so that writers/editors/reviewers have an understanding of the Amerigroup proposal process.

6. Perform relevant segments of aforementioned training (Corporate background and experience, process, roles and responsibilities, etc).

7. Provide Leadership to the department and participate in constructive assistance to other writers including consultants; Assist with the on-going. management/administration of proposal writers and editors (associates and consultants) in the Amerigroup database.

8. Conduct research to obtain information for proposal content development. Prepare presentation documents with content and direction provided by others.

9. Lead kick-off, strategy, and debrief meetings respective to writing assignments.

10. Develop responses to complex RFP/RFI requirements by working with identified SMEs to determine and develop responses for specific content for assigned sections.

11. Write assigned sections ensuring compliance with the RFP/RFI requirements. Proofread proposals to apply company standards for accuracy, quality writing, and marketing focus. Revise sections as directed.

12. Conceptualize supporting graphics for documents to illustrate and simplify concepts; work with assigned graphic designers to produce final versions of illustrations for insertion into the document.

13. Lead the online market analysis and proposal content database maintenance process.

14. Perform other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in English, Marketing, Journalism, Communications or Health Systems Administration with twice the required management and writing experience listed below.

Preferred:
- Master’s degree in English, Marketing, Journalism, Communications or Health Systems Administration.

Years and Type of Experience Required:

Required:
- Minimum of five (5) years experience with proposal-development writing and project management on large and complex RFP responses.
- Minimum of three (3) years managing and training internal or consultant team members, specifically in the areas of writing, editing, RFP review, or project management.
- Demonstrated success in proposal writing.
- Excellent skills in writing clear and focused copy that meets strategy and objectives.
- Demonstrated success in managing projects from conception to execution.

Preferred:
- Minimum of seven (7) years experience with proposal-development writing and project management on large and complex RFP responses.
- Technical writing or proposal development in the health-insurance field.
- Working knowledge of Medicaid or other public-sector healthcare program.
- Excellent project management and planning skills.
- Working knowledge of publication production tools.
- Experience as a proposal evaluator.

Certifications or Licensures

Required:
- N/A

Preferred:
- Association of Proposal Management Professionals (APMP) Foundation, Practitioner, or Professional Accreditation.

Functional Competencies
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks.
- Working knowledge in a windows environment, in particular with Word, PowerPoint, and Excel, to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize, and edit data.
- Preferred working knowledge of publication production tools.
- Ability to use software to conduct data analysis, reporting, and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 10-15

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.


]]>Tue, 14 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Manager-Proposal-Writing-&-Editing-Job-VA-23450/2597180/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Manager-Proposal-Writing-&-Editing-Job-VA-23450/2597180/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22383 # Positions 1
Location US-MD-Hanover
Search Category Sales & Marketing
Type Regular Full-Time (30+ hours) Posted Date 3/25/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for growing membership through educating and servicing the Medicaid population; including meeting the communities need for ongoing educational and social service outreach to existing and potential members.

***Bilingual (English/Spanish) reading, writing and speaking skills desired.

Responsibilities:

1. Acts as service representative for assigned projects and acts as a resource to the membership and the community as needed.

2. Ensure consistent compliance with all state, federal and Amerigroup specific requirements.

3. Assist with establishing and maintaining positive relationships with community organizations, provider offices, faith based organizations and perform other activities to enhance Amerigroup’s presence in the community.

4. Conducts presentations, staff exhibits and perform other activities in an effort to maintain and establish positive relationships with providers, community and faith based organizations.

5. Identify and collect educational material on community networks and advocacy groups with similar missions and values and communicate the information to management.

6. Provides telephonic assistance, outreach and/or guidance to members and potential members regarding benefit and enrollment questions, and/or providing assistance on any social service needs.

7. Assists potential and existing members with the enrollment or recertification process, where appropriate and compliant with local market regulations.

8. Supports health education activities and referral of members to health education programs.

9. Represents Amerigroup at community organizations and events such as promotions, enrollment events (where appropriate and compliant with local market regulations.) and health fairs.

10. Identifies cultural issues regarding current and potential members and communicates those issues and concerns to management.

11. Assists with retention activities necessary to ensure resolution to members around continuity of care issues.

12. Assists with activities necessary to ensure resolution to potential members around continuity of care issues.

13. May be required to drive COV per plan requirements.

14. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School

Preferred:
- Associates Degree or BS/BA degree.

Years and Type of Experience Required:

Required:
- 1 yr experience in healthcare or sales/marketing environment.

Certifications or Licensures

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

Preferred:
- Valid state health insurance licensure.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Basic
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment, in particular with Word and Excel, to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Experience working with SalesForce.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.

Read, Interpret and Apply information - Basic
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

Behavioral Competencies

Strategic Leadership

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

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

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

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

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

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

Other:
- Able to present information verbally, and in writing, in a concise and effective manner.
- Demonstrate ownership skills when handling internal or external customer concerns or issues.
- Able to identify problems and develop satisfying solutions.
- Demonstrates motivation and innovation for self-improvement.
- Demonstrates basic understanding of healthcare industry.
- Demonstrates knowledge of how position is related to unit/team within a department.
- Able to participate in teams as a strong team participant.

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 lift 25 pounds or more.
- Must be able to sit for long periods of time.

ermSM
]]>Tue, 23 Apr 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Hanover-Marketing-Rep-I-Job-MD-21075/2504228/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Hanover-Marketing-Rep-I-Job-MD-21075/2504228/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22485 # Positions 1
Location US-LA-Metairie
Search Category Medical Director
Type Regular Full-Time (30+ hours) Posted Date 4/4/2013
Additional Locations ..

More information about this job:
Summary:

Provides support in overseeing medical care for Amerigroup products and services and works collaboratively with other functions that interface with medical management such as provider relations, member services, benefits and claims management. Collaborates with other business leaders, corporate and health plan medical directors to carry out national medical policies.

Responsibilities:

1. Assists in managing medical costs and assuring appropriate health care delivery for Amerigroup health plans, products and services.

2. Provides guidance, support and leadership for utilization management activities.

3. Supports Medical Director(s) in all aspects of utilization, quality and network management.

4. Provides support to nurses and clinical leaders in pre-authorization, concurrent and retrospective review decisions, case management and disease management decisions.

5. Assists Medical Directors and/or National Medical Directors with medical policy; participates in policy review, reviews trends and makes recommendations; may plan, organize and/or direct medical services programs, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.

6. Assists in the design and implementation of corrective action plans to address issues and improve plan and network managed care performance.

7. Supports URAC, AHCA and NCQA qualification activities. Prepare for site visits and responds to accrediting and regulatory agency feedback.

8. Participates in risk management, claims adjudication, utilization management, catastrophic case review, education and outreach programs, HEDIS reporting, credentialing, peer to peer review, appeals review, denials, etc.

9. Participates in the development of strategic planning for existing and expanding business. Recommends changes in program content in concurrence with changing markets and technologies.

10. Other duties as assigned or requested

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- MD or DO, with board certification in area of specialty.

Preferred:
- Masters in Public Health, MBA or MA.

Years and Type of Experience Required:

Required:
- Minimum of five years clinical experience with at least two years in medical management/health administration in a managed care environment.

Certifications or Licensures

Required:
- Active license to practice medicine without restriction issued by the State Board of Licensure or the State Board of Osteopathic Examiners. Certified in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS).

Preferred:
- Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management

Language Skills

Required:
- English

Functional Competencies
- Think creatively, Innovative
- Understanding of financial and business acumen
- Collaborative team player; active listening skills
- Excellent verbal and written communication skills and ability to build and sustain strong working relationships
- Organizational skills and demonstrated ability to multitask and execute
- Strong people leadership and influencing skills
- Strong project management skills; ability to drive programs and lead change
- Knowledge of medical, quality improvement and utilization management practices in a managed care environment
- Knowledge of regulatory and accreditation agencies and requirements
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.
- Ability to read, comprehend and interpret complex information and trends to provide accurate and appropriate information to business partners and/or customers.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.

SCOPE INFORMATION

# Direct Reports: As assigned

# Indirect Reports: As assigned

Budgetary $ Responsibility: As assigned

PHYSICAL REQUIREMENTS

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

CB1

ermEL
]]>Fri, 03 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Metairie-Medical-Director-New-Orleans-Job-LA-70001/2530353/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Metairie-Medical-Director-New-Orleans-Job-LA-70001/2530353/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22662 # Positions 1
Location US-NY-New York
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/24/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

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

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

9. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Years and Type of Experience Required:

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

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

Certifications or Licensures

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

Language Skills

Required:
- English

Functional Competencies

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

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

PHYSICAL REQUIREMENTS

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

ermCS
]]>Wed, 24 Apr 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/New-York-Medical-Coding-Analyst-Auditor-CPC-Certified-Job-NY/2564575/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/New-York-Medical-Coding-Analyst-Auditor-CPC-Certified-Job-NY/2564575/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-21239 # Positions 1
Location US-NATIONWIDE
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 11/14/2012
Additional Locations ..

More information about this job:
Summary:

The HCE Analyst III is responsible for collecting, analyzing and interpreting health care data, including claims, clinical, member, and provider information applying problem solving skills to deal creatively with complex less clearly defined situations. Works directly with Plan and Corporate Office customers and business owners to provide solutions to problems of diverse scope with the goal of identifying areas of opportunity for formulation and implementation of strategic initiatives.

Responsibilities:

1. Responsible for conducting advanced data management.

2. Develops and executes complex programs to produce reporting deliverables.

3. Performs business requirements gathering and analysis.

4. Provides technical and/or analytical support as well as professional development to Plan Performance measurement staff.

5. Collaborates with internal and external partners and organizations to understand data needs and design analytic studies to answer business and research questions.

6. Independently structures advanced level project plans for analytical projects.

7. Interprets results and prepares findings for presentation to internal and external audiences.

8. Conducts quality reviews on own and peers’ work products.

9. Integrates feedback to drive continuous improvement and grow subject matter knowledge.

10. Applies advanced financial, clinical and/or operational analysis.

11. Monitors and identifies unit cost and/or utilization risks to AMERIGROUP’s medical cost budget. Elevates and presents to HCE management as necessary.

12. Adheres to all applicable compliance standards.

13. Other job duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Finance, Economics, Business Administration or a related discipline or equivalent experience.

Years and Type of Experience Required:

Required:
- Minimum of five years of related work experience in data analysis, report development, application development/implementation and /or project management.

Preferred:
- Minimum of two years experience with Managed Care Organization.
- Minimum of two years experience with government health care programs.

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Proficiency with Microsoft Office products, Excel in particular.
- Programming language such as SQL or SAS preferred Communication skills: Verbal, Written and Telephonic.
- Strong capability to provide professional and appropriate written and verbal information to internal and external customers.
- Strong customer service/relationship skills and ability to work effectively and multi-task in a fast paced environment with shifting priorities.

Behavioral Competencies

Strategic Leadership

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

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

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

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

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

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Tue, 23 Apr 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-HCE-Analyst-III-Provider-Collaboration-Analytics-Job-VA-23450/2275979/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-HCE-Analyst-III-Provider-Collaboration-Analytics-Job-VA-23450/2275979/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22511 # Positions 1
Location US-NATIONWIDE
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 4/8/2013
Additional Locations ..

More information about this job:
Summary:

The HCE Analyst III is responsible for collecting, analyzing and interpreting health care data, including claims, clinical, member, and provider information applying problem solving skills to deal creatively with complex less clearly defined situations. Works directly with Plan and Corporate Office customers and business owners to provide solutions to problems of diverse scope with the goal of identifying areas of opportunity for formulation and implementation of strategic initiatives.

Responsibilities:

1. Responsible for conducting advanced data management.

2. Develops and executes complex programs to produce reporting deliverables.

3. Performs business requirements gathering and analysis.

4. Provides technical and/or analytical support as well as professional development to Plan Performance measurement staff.

5. Collaborates with internal and external partners and organizations to understand data needs and design analytic studies to answer business and research questions.

6. Independently structures advanced level project plans for analytical projects.

7. Interprets results and prepares findings for presentation to internal and external audiences.

8. Conducts quality reviews on own and peers’ work products.

9. Integrates feedback to drive continuous improvement and grow subject matter knowledge.

10. Applies advanced financial, clinical and/or operational analysis.

11. Monitors and identifies unit cost and/or utilization risks to AMERIGROUP’s medical cost budget. Elevates and presents to HCE management as necessary.

12. Adheres to all applicable compliance standards.

13. Other job duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Finance, Economics, Business Administration or a related discipline or equivalent experience.

Years and Type of Experience Required:

Required:
- Minimum of five years of related work experience in data analysis, report development, application development/implementation and /or project management.

Preferred:
- Minimum of two years experience with Managed Care Organization.
- Minimum of two years experience with government health care programs.

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Proficiency with Microsoft Office products, Excel in particular.
- Programming language such as SQL or SAS preferred Communication skills: Verbal, Written and Telephonic.
- Strong capability to provide professional and appropriate written and verbal information to internal and external customers.
- Strong customer service/relationship skills and ability to work effectively and multi-task in a fast paced environment with shifting priorities.

Behavioral Competencies

Strategic Leadership

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

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

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

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

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

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Tue, 07 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Health-Care-Economics-Analyst-III-%28Encounters%29-Job/2535079/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Health-Care-Economics-Analyst-III-%28Encounters%29-Job/2535079/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22296 # Positions 1
Location US-NATIONWIDE
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 3/14/2013
Additional Locations ..

More information about this job:
Summary:

As part of the Medicare Risk Adjustment team, the Health Care Analytics III will develop expert knowledge of the CMS-HCC risk adjustment model, its concepts and methodology in order to reconcile CMS risk score reports and project future revenue related to risk adjustment. In addition to ensuring the accuracy, quality and integrity of the data, this person will perform detailed and complex analyses in order to evaluate risk score trends with special focus on provider-level reporting. The ideal candidate for this position will be proficient in SQL or SAS and have a strong analytic experience; additionally, they need to be results oriented and willing to do whatever it takes to manage a project to completion. Experience with risk adjustment is preferred.

The Analyst III is responsible for collecting, analyzing and interpreting health care data, including claims, clinical, member, and provider information applying problem solving skills to deal creatively with complex less clearly defined situations. Works directly with Plan and Corporate Office customers and business owners to provide solutions to problems of diverse scope with the goal of identifying areas of opportunity for formulation and implementation of strategic initiatives.

Responsibilities:

1. Responsible for conducting advanced data management.

2. Develops and executes complex programs to produce reporting deliverables.

3. Performs business requirements gathering and analysis.

4. Provides technical and/or analytical support as well as professional development to Plan Performance measurement staff.

5. Collaborates with internal and external partners and organizations to understand data needs and design analytic studies to answer business and research questions.

6. Independently structures advanced level project plans for analytical projects.

7. Interprets results and prepares findings for presentation to internal and external audiences.

8. Conducts quality reviews on own and peers’ work products.

9. Integrates feedback to drive continuous improvement and grow subject matter knowledge.

10. Applies advanced financial, clinical and/or operational analysis.

11. Monitors and identifies unit cost and/or utilization risks to AMERIGROUP’s medical cost budget.

12. Adheres to all applicable compliance standards.

13. Other job duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Finance, Economics, Business Administration or a related discipline or equivalent experience.

Years and Type of Experience Required:

Required:
- Minimum of five years of related work experience in data analysis, report development, application development/implementation and /or project management.

Preferred:
- Minimum of two years experience with Managed Care Organization.
- Minimum of two years experience with government health care programs.

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Proficiency with Microsoft Office products, Excel in particular.
- Programming language such as SQL or SAS preferred Communication skills: Verbal, Written and Telephonic.
- Strong capability to provide professional and appropriate written and verbal information to internal and external customers.
- Strong customer service/relationship skills and ability to work effectively and multi-task in a fast paced environment with shifting priorities.

Behavioral Competencies

Strategic Leadership

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

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

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

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

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

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Sat, 11 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Medicare-Risk-Adjustment-Analyst-III-%28position-located-in-Virginia-Beach%29-Job/2480263/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Medicare-Risk-Adjustment-Analyst-III-%28position-located-in-Virginia-Beach%29-Job/2480263/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22893 # Positions 1
Location US-NATIONWIDE
Search Category Quality
Type Regular Full-Time (30+ hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

The HCE Analyst III – Fraud, Waste, and Abuse Modeler is responsible for the developing, monitoring, and improving business rules and models to identify suspect providers, inclusive of facilities. The ideal candidate has interest in health care fraud, waste, and abuse trends and strong background in analytics, statistics, and/or building predictive models.

Responsibilities:

1. Responsible for conducting advanced data management.

2. Develops and executes complex programs to produce reporting deliverables.

3. Performs business requirements gathering and analysis.

4. Provides technical and/or analytical support as well as professional development to Plan Performance measurement staff.

5. Collaborates with internal and external partners and organizations to understand data needs and design analytic studies to answer business and research questions.

6. Independently structures advanced level project plans for analytical projects.

7. Interprets results and prepares findings for presentation to internal and external audiences.

8. Conducts quality reviews on own and peers’ work products.

9. Integrates feedback to drive continuous improvement and grow subject matter knowledge.

10. Applies advanced financial, clinical and/or operational analysis.

11. Monitors and identifies unit cost and/or utilization risks to AMERIGROUP’s medical cost budget. Elevates and presents to HCE management as necessary.

12. Adheres to all applicable compliance standards.

13. Other job duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Finance, Economics, Business Administration or a related discipline or equivalent experience.

Preferred:
- Master’s degree or doctorate in Computer Science, Statistics, Mathematics, Finance, Economics or related disciplines.

Years and Type of Experience Required:

Required:
- Minimum of five years of related work experience in data analysis, report development, application development/implementation and /or project management.

Preferred:
- Minimum of two years experience with Managed Care Organization.
- Minimum of two years experience with government health care programs.
- Minimum one year of experience with fraud, waste, and abuse domain in Managed Care Organizations and government health care programs.
- Minimum one year of experience with data manipulation and predictive model building/deployment.
- Minimum one year of experience with programming/scripting languages

Language Skills

Required:
- English

Communication skills

Verbal, Written and Telephonic
- Strong capability to provide professional and appropriate written and verbal information to internal and external customers.
- Strong customer service/relationship skills and ability to work effectively and multi-task in a fast paced environment with shifting priorities.

Computer Skills and Office Equipment
- Proficiency with Microsoft Office products, Excel in particular.
- Programming language such as SQL or SAS preferred Communication skills: Verbal, Written and Telephonic.
- Strong capability to provide professional and appropriate written and verbal information to internal and external customers.
- Strong customer service/relationship skills and ability to work effectively and multi-task in a fast paced environment with shifting priorities.

Behavioral Competencies

Strategic Leadership

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

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

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

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

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

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

PHYSICAL REQUIREMENTS

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

D: JR

ermHO
]]>Fri, 17 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Health-Care-Economics-Analyst-III-StatisticianLogistics-Modeling-%28position-located-Job/2604271/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Health-Care-Economics-Analyst-III-StatisticianLogistics-Modeling-%28position-located-Job/2604271/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22450 # Positions 1
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/1/2013
Additional Locations ..

More information about this job:
Summary:

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

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

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

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

Responsibilities:

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

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

3. Plans, organizes and manages call center activities.

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

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

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

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

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

9. Manages salary and expense budgets.

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

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

12. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

Preferred:
- Significant experience within managed care operations.

Certifications or Licensures

Preferred:
- Green belt certification.

Language Skills

Required:
- English

Preferred:
- Other languages as determined by business need.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment - Advanced
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.

Communication Skills: Verbal, Written and Call Handling - Advanced
- Ability to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style in the preparation of verbal and written messages to business partners and customers.
- Ability to prepare, edit and clearly convey a variety of messages including presentations, training materials and updates. Ability to handle escalated issues to diffuse concerns through verbal and written messages.

Heath Care Industry Terminology
- Ability to understand basic health care industry terms. Ability to understand how an insurance claim works and use the explanation of benefits to explain details to providers and related business partners.

Read, Interpret and Apply information - Advanced
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

Behavioral Competencies

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

SCOPE INFORMATION

# Direct Reports: 3-8

# Indirect Reports: 125-150

PHYSICAL REQUIREMENTS

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

ermCS
]]>Thu, 02 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Director-Customer-Care-Job-VA-23450/2523308/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Director-Customer-Care-Job-VA-23450/2523308/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22649 # Positions 1
Location US-TN-Nashville
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/24/2013
Additional Locations ..

More information about this job:
Summary:

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

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

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

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

Responsibilities:

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

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

3. Plans, organizes and manages call center activities.

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

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

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

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

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

9. Manages salary and expense budgets.

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

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

12. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

Preferred:
- Significant experience within managed care operations.

Certifications or Licensures

Preferred:
- Green belt certification.

Language Skills

Required:
- English

Preferred:
- Other languages as determined by business need.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment - Advanced
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.

Communication Skills: Verbal, Written and Call Handling - Advanced
- Ability to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style in the preparation of verbal and written messages to business partners and customers.
- Ability to prepare, edit and clearly convey a variety of messages including presentations, training materials and updates. Ability to handle escalated issues to diffuse concerns through verbal and written messages.

Heath Care Industry Terminology
- Ability to understand basic health care industry terms. Ability to understand how an insurance claim works and use the explanation of benefits to explain details to providers and related business partners.

Read, Interpret and Apply information - Advanced
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

Behavioral Competencies

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

SCOPE INFORMATION

# Direct Reports: 3-8

# Indirect Reports: 125-150

PHYSICAL REQUIREMENTS

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

ermCS
]]>Wed, 24 Apr 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Nashville-Director-Customer-Care-Job-TN-37201/2564577/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Nashville-Director-Customer-Care-Job-TN-37201/2564577/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22141 # Positions 1
Location US-VA-Norfolk
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 3/14/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

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

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

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

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

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

12. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Years and Type of Experience Required:

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

Certifications or Licensures

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

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

Language Skills

Required:
- English

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

PHYSICAL REQUIREMENTS

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

ermCS
]]>Sat, 11 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Norfolk-Sr-Medical-Coding-Analyst-Job-VA-23501/2480267/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Norfolk-Sr-Medical-Coding-Analyst-Job-VA-23501/2480267/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-21589 # Positions 1
Location US-VA-Norfolk
US-VA-Richmond
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 1/7/2013
Additional Locations US-VA-Richmond

More information about this job:
Summary:

Develop, implement and manage both corporate initiated and health plan initiated programs targeted at wellness, early intervention, education and member/provider communications. Provide oversight,coordination and collaboration across health plans and corporate departments. Ensures that all health education materials meet best clinical practice guidelines and are in compliance with Amerigroup Clinical Practice Guidelines (CPGs), policies and regulatory requirements.

Responsibilities:

1. Develop strategies and programs to promote a culture of health and healthly lifestype behaviors. Investigates and recommends management strategies that can enhance Amerigroup’s ability to provide members and providers with cutting edge services and programs.

2. Oversee the tracking and timeliness of all deliverables, to include appropriate quality metrics and IT support systems to ensure appropriate resources are in place to support the workflow and volume.

3. Coordinate National Health Promotion initiatives that meet state regulatory, accreditation, HEDIS and clinical needs.

4. Coordinate all appropriate initiatives with the Behavioral Health clinical staff to ensure broad communication and validation is achieved.

5. Evaluate strategies for ongoing efficiency, effectiveness and appropriateness. Works with health plans to evaluate effectiveness of the program and to implement changes based on evaluation outcomes.

6. Work with IS and QM departments assisting in the development and implementation of survey instruments, data collection tools and reports related to the needs of the member/provider.

7. Provide input to senior management regarding program needs and new areas for program services development. Identify and recommend activities/services that promote member compliance/participation and retention.

8. Prepares summaries of activities and services, accomplishment reports, department updates and submits required reports to QM or other departments as directed. Create outcome focused management reports based on the identified business plan goals and objectives.

9. Assist with orientation and training of volunteers and students involved in prevention, education and outreach activities and events.

10. Participate in budget planning for the department and maintains expenses within the budget. Ensure’s expenditures are made in accordance with applicable policies and procedures.

11. Coach and develop team members; establish goals, performance standards and operating procedures. Act as an advisor to less experience staff.

12. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Years and Type of Experience Required:

Required:
- Entry level position for associates who have had sufficient educational background and/or experience to qualify them to start in applications systems analysis.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment – Basic
- Basic understanding of core IT applications and systems and infrastructure associated with supported applications.
- Ability to use hardware and software of a computer to complete certain simple tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Applications System Analysis - Basic
- Basic understanding of coding standards. Basic understanding of object oriented development language, object state and methods, and encapsulation. Basic understanding of variables, data types, expressions, control flow statements, arrays and strings. Understands data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types.

Project Management - Basic
- Basic understanding of project management concepts.

Behavioral Competencies

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

PHYSICAL REQUIREMENTS

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

CB1

ermHO
]]>Sat, 18 May 2013 05:31:00 GMThttp://www.amerigroup-jobs.com/job/Norfolk-Director-HCMS-Behavioral-Health-Job-VA-23501/2362478/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Norfolk-Director-HCMS-Behavioral-Health-Job-VA-23501/2362478/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22727 # Positions 10
Location US-GA-Atlanta
Search Category Sales & Marketing
Type Regular Full-Time (30+ hours) Posted Date 5/2/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for growing membership through educating and servicing the Medicaid population; including meeting the communities need for ongoing educational and social service outreach to existing and potential members.

Our Marketing Department has a need for Marketing Consultants/ Contractors in the following areas;
- North GA - Dalton/ Whitefield Co (Bi-lingual REQUIRED)
- East / Richmond Co.
- Southeast – Brunswick / Glynn & Camden Co
- Central Region – Macon / Bibb Co

Responsibilities:

1. Acts as service representative for assigned projects and acts as a resource to the membership and the community as needed.

2. Ensure consistent compliance with all state, federal and Amerigroup specific requirements.

3. Assist with establishing and maintaining positive relationships with community organizations, provider offices, faith based organizations and perform other activities to enhance Amerigroup’s presence in the community.

4. Conducts presentations, staff exhibits and perform other activities in an effort to maintain and establish positive relationships with providers, community and faith based organizations.

5. Identify and collect educational material on community networks and advocacy groups with similar missions and values and communicate the information to management.

6. Provides telephonic assistance, outreach and/or guidance to members and potential members regarding benefit and enrollment questions, and/or providing assistance on any social service needs.

7. Assists potential and existing members with the enrollment or recertification process, where appropriate and compliant with local market regulations.

8. Supports health education activities and referral of members to health education programs.

9. Represents Amerigroup at community organizations and events such as promotions, enrollment events (where appropriate and compliant with local market regulations.) and health fairs.

10. Identifies cultural issues regarding current and potential members and communicates those issues and concerns to management.

11. Assists with retention activities necessary to ensure resolution to members around continuity of care issues.

12. Assists with activities necessary to ensure resolution to potential members around continuity of care issues.

13. May be required to drive COV per plan requirements.

14. Other duties as assigned.

ADDITIONAL REQUIREMENTS:

Our Marketing Department has a need for Marketing Consultants/ Contractors in the following areas;

North GA - Dalton/ Whitefield Co (Bi-lingual REQUIRED)

East / Richmond Co.

Southeast – Brunswick / Glynn & Camden Co

Central Region – Macon / Bibb Co

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School

Preferred:
- Associates Degree or BS/BA degree.

Years and Type of Experience Required:

Required:
- 1 yr experience in healthcare or sales/marketing environment.

Certifications or Licensures

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

Preferred:
- Valid state health insurance licensure.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Basic
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment, in particular with Word and Excel, to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Experience working with SalesForce.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.

Read, Interpret and Apply information - Basic
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

Behavioral Competencies

Strategic Leadership

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

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

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

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

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

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

Other:
- Able to present information verbally, and in writing, in a concise and effective manner.
- Demonstrate ownership skills when handling internal or external customer concerns or issues.
- Able to identify problems and develop satisfying solutions.
- Demonstrates motivation and innovation for self-improvement.
- Demonstrates basic understanding of healthcare industry.
- Demonstrates knowledge of how position is related to unit/team within a department.
- Able to participate in teams as a strong team participant.

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 lift 25 pounds or more.
- Must be able to sit for long periods of time.

ermSM
]]>Thu, 02 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Atlanta-Marketing-Rep-Consultants-%28Dalton-Co_-Bi-lingual-REQUIRED%2C-Whitefield-Co_-Bi-lin-Job-GA-30301/2578751/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Atlanta-Marketing-Rep-Consultants-%28Dalton-Co_-Bi-lingual-REQUIRED%2C-Whitefield-Co_-Bi-lin-Job-GA-30301/2578751/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-20398 # Positions 1
Location US-TX-Grand Prairie
Search Category Medical Director
Type Regular Full-Time (30+ hours) Posted Date 9/11/2012
Additional Locations ..

More information about this job:
Summary:

Responsible and accountable for assuring appropriate health care delivery for Amerigroup health plans, products and services. Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality, cost and outcomes. Interprets existing medical policies and participates in the development and execution of new policies based on changes in the healthcare or medical arena Supports medical management and other health plan staff in timely and consistent responses to members and providers.

Responsibilities:

1. Designs and implements corporate and/or health plan medical policies, goals and objectives, reviews trends and makes recommendations; plans, organizes and directs medical services programs, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.

2. Assists with the development of budgets, staffing plans and medical loss ratio projections, assuring the adequate allocation of resources to the medical management functions.

3. Provides professional leadership and direction to the functions within Medical Management, to include Utilization and Case Management, Cost Management and Clinical Quality Management.

4. Drives provider collaboration initiatives and performance monitoring; designs and implements corrective action plans to address issues and improve plan and network managed care performance.

5. Collaborates with provider and government/external relations to improve brand reputation and credibility with constituents.

6. Participates in the retrospective review and analysis of health plan performance from analyzing trends and summary data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources.

7. Supports URAC, AHCA and NCQA qualification activities. Prepares for site visits and responds to accrediting and regulatory agency feedback.

8. Participates in risk management, claims adjudication, utilization management, catastrophic case review, education and outreach programs, HEDIS reporting, credentialing, peer to peer review, appeals review, denials, etc.

9. Participates in the development of strategic planning for existing and expanding business. Recommends changes in program content in concurrence with changing markets and technologies.

10. Monitors member and provider satisfaction survey results and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.

11. Assists with the contracting process for providers, hospitals, ancillary providers and emergency and other supports services and evaluates the medical aspects of provider contracts.

12. Other duties as assigned or requested

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- MD or DO, with board certification in area of specialty

Preferred:
- Masters in Public Health, MBA or MA Years and Type of Experience Required: Required:
- Minimum of ten years clinical experience with at least three years in medical management/health administration in a managed care environment.
- Minimum of 7 years of leadership/management experience.
- Extensive managed care or Medicare knowledge

Certifications or Licensures

Required:
- Active license to practice medicine without restriction issued by the State Board of Licensure or the State Board of Osteopathic Examiners. Certified in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS).

Preferred:
- Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management

Language Skills

Required:
- English

Functional Competencies
- Think creatively, Innovative
- Understanding of financial and business acumen
- Collaborative team player; active listening skills
- Excellent verbal and written communication skills and ability to build and sustain strong working relationships
- Organizational skills and demonstrated ability to multitask and execute
- Strong people leadership and influencing skills
- Strong project management skills; ability to drive programs and lead change
- Knowledge of medical, quality improvement and utilization management practices in a managed care environment
- Knowledge of regulatory and accreditation agencies and requirements
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.
- Ability to read, comprehend and interpret complex information and trends to provide accurate and appropriate information to business partners and/or customers.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.

SCOPE INFORMATION

# Direct Reports: 0-5

# Indirect Reports: 0-75

Budgetary $ Responsibility: Varies

PHYSICAL REQUIREMENTS

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

HEC:DW

ermEL
]]>Tue, 30 Apr 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Sr-Medical-Dir-Job-TX-77001/2144639/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Sr-Medical-Dir-Job-TX-77001/2144639/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22730 # Positions 1
Location US-TX-Grand Prairie
Search Category Medical Director
Type Regular Full-Time (30+ hours) Posted Date 5/2/2013
Additional Locations ..

More information about this job:
Summary:

Responsible and accountable for assuring appropriate health care delivery for Amerigroup health plans, products and services. Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality, cost and outcomes. Interprets existing medical policies and participates in the development and execution of new policies based on changes in the healthcare or medical arena Supports medical management and other health plan staff in timely and consistent responses to members and providers.

Responsibilities:

1. Designs and implements corporate and/or health plan medical policies, goals and objectives, reviews trends and makes recommendations; plans, organizes and directs medical services programs, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.

2. Assists with the development of budgets, staffing plans and medical loss ratio projections, assuring the adequate allocation of resources to the medical management functions.

3. Provides professional leadership and direction to the functions within Medical Management, to include Utilization and Case Management, Cost Management and Clinical Quality Management.

4. Drives provider collaboration initiatives and performance monitoring; designs and implements corrective action plans to address issues and improve plan and network managed care performance.

5. Collaborates with provider and government/external relations to improve brand reputation and credibility with constituents.

6. Participates in the retrospective review and analysis of health plan performance from analyzing trends and summary data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources.

7. Supports URAC, AHCA and NCQA qualification activities. Prepares for site visits and responds to accrediting and regulatory agency feedback.

8. Participates in risk management, claims adjudication, utilization management, catastrophic case review, education and outreach programs, HEDIS reporting, credentialing, peer to peer review, appeals review, denials, etc.

9. Participates in the development of strategic planning for existing and expanding business. Recommends changes in program content in concurrence with changing markets and technologies.

10. Monitors member and provider satisfaction survey results and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.

11. Assists with the contracting process for providers, hospitals, ancillary providers and emergency and other supports services and evaluates the medical aspects of provider contracts.

12. Other duties as assigned or requested

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- MD or DO, with board certification in area of specialty

Preferred:
- Masters in Public Health, MBA or MA Years and Type of Experience Required: Required:
- Minimum of ten years clinical experience with at least three years in medical management/health administration in a managed care environment.
- Minimum of 7 years of leadership/management experience.
- Extensive managed care or Medicare knowledge

Certifications or Licensures

Required:
- Active license to practice medicine without restriction issued by the State Board of Licensure or the State Board of Osteopathic Examiners. Certified in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS).

Preferred:
- Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management

Language Skills

Required:
- English

Functional Competencies
- Think creatively, Innovative
- Understanding of financial and business acumen
- Collaborative team player; active listening skills
- Excellent verbal and written communication skills and ability to build and sustain strong working relationships
- Organizational skills and demonstrated ability to multitask and execute
- Strong people leadership and influencing skills
- Strong project management skills; ability to drive programs and lead change
- Knowledge of medical, quality improvement and utilization management practices in a managed care environment
- Knowledge of regulatory and accreditation agencies and requirements
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.
- Ability to read, comprehend and interpret complex information and trends to provide accurate and appropriate information to business partners and/or customers.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.

SCOPE INFORMATION

# Direct Reports: 0-5

# Indirect Reports: 0-75

Budgetary $ Responsibility: Varies

PHYSICAL REQUIREMENTS

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

CB1

ermEL
]]>Thu, 02 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Grand-Prairie-Sr-Medical-Dir-DFW-TEXAS-Job-TX-75050/2578754/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Grand-Prairie-Sr-Medical-Dir-DFW-TEXAS-Job-TX-75050/2578754/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22520 # Positions 3
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 4/8/2013
Additional Locations ..

More information about this job:
Summary:

The HCE Analyst III is responsible for collecting, analyzing and interpreting health care data, including claims, clinical, member, and provider information applying problem solving skills to deal creatively with complex less clearly defined situations. Works directly with Plan and Corporate Office customers and business owners to provide solutions to problems of diverse scope with the goal of identifying areas of opportunity for formulation and implementation of strategic initiatives.

Responsibilities:

1. Responsible for conducting advanced data management.

2. Develops and executes complex programs to produce reporting deliverables.

3. Performs business requirements gathering and analysis.

4. Provides technical and/or analytical support as well as professional development to Plan Performance measurement staff.

5. Collaborates with internal and external partners and organizations to understand data needs and design analytic studies to answer business and research questions.

6. Independently structures advanced level project plans for analytical projects.

7. Interprets results and prepares findings for presentation to internal and external audiences.

8. Conducts quality reviews on own and peers’ work products.

9. Integrates feedback to drive continuous improvement and grow subject matter knowledge.

10. Applies advanced financial, clinical and/or operational analysis.

11. Monitors and identifies unit cost and/or utilization risks to AMERIGROUP’s medical cost budget. Elevates and presents to HCE management as necessary.

12. Adheres to all applicable compliance standards.

13. Other job duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Finance, Economics, Business Administration or a related discipline or equivalent experience.

Years and Type of Experience Required:

Required:
- Minimum of five years of related work experience in data analysis, report development, application development/implementation and /or project management.

Preferred:
- Minimum of two years experience with Managed Care Organization.
- Minimum of two years experience with government health care programs.

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Proficiency with Microsoft Office products, Excel in particular.
- Programming language such as SQL or SAS preferred Communication skills: Verbal, Written and Telephonic.
- Strong capability to provide professional and appropriate written and verbal information to internal and external customers.
- Strong customer service/relationship skills and ability to work effectively and multi-task in a fast paced environment with shifting priorities.

Behavioral Competencies

Strategic Leadership

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

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

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

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

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

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

PHYSICAL REQUIREMENTS

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

ermIT
]]>Tue, 07 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Business-Analyst-III-%28position-located-in-Virginia-Beach%29-Job/2535072/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Business-Analyst-III-%28position-located-in-Virginia-Beach%29-Job/2535072/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22283 # Positions 1
Location US-VA-Virginia Beach
Search Category Finance
Type Regular Full-Time (30+ hours) Posted Date 3/13/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

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

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

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

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

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

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

13. Other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Years and Type of Experience Required:

Required:
- Minimum 5 years experience in analytical role

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

Specific Technical Skills

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

Other:

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

PHYSICAL REQUIREMENTS

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

ermCorp
]]>Fri, 10 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Premium-Billing-Analyst-III-Job-VA-23450/2477771/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Premium-Billing-Analyst-III-Job-VA-23450/2477771/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22619 # Positions 40
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/18/2013
Additional Locations ..

More information about this job:
Summary:

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

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

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

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

Responsibilities:

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

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

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

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

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

6. Meets or exceeds established quality and production standards.

7. Reviews and responds to quality audits.

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

9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High school diploma or GED.

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

Years and Type of Experience Required:

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

Preferred:
- Two years of claims processing experience.

Language Skills

Required:
- English

Technical Competencies

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

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

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

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

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

Behavioral Competencies

Strategic Leadership

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

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

People Leadership

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

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

Results Leadership

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

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

PHYSICAL REQUIREMENTS

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

ermCS
]]>Sat, 18 May 2013 05:31:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Claims-Analyst-Job-VA-23450/2556791/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Claims-Analyst-Job-VA-23450/2556791/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS