http://www.amerigroup-jobs.com/feeds/provider-relations-jobs/ Custom RSS Feed for provider-relations-jobs Thu, 09 Sep 2010 19:09:55 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/feeds/provider-relations-jobs/ 720
Job ID: 2010-11872
# Positions: 1
Location: US-VA-Merrifield
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

Responsible for providing the Health Plan with expertise in physician, physician group, hospital and ancillary healthcare contracting and provider reimbursement methodologies, taking the lead or assisting on Provider Relations projects in existing, expansion and new markets. Works with senior management to develop contracting and financial strategies, execute strategies, and maintain positive provider relationships while advancing the goals of the Health Plan. Responsible for oversight of Provider Relations staff and servicing activities, including resolution of complex operational issues impacting provider relationships.

Responsibilities:

1. Assist Health Plan senior staff in interacting and negotiating with the provider?s most senior clinical and administrative executives.
2. Collaborate with the CEO/COO and other Health Plan senior management to determine the Plan?s provider contracting needs
3. Work with Health Plan CEO/COO and other appropriate senior management in the development of provider network business plans, strategies and goals as they relate to network expansion and provider contracting, education, communication, policies, procedures and servicing
4. Work with Plan senior management to develop provider network related earnings improvement initiatives as well as network growth and expansion initiatives.
5. Develop and implement Provider Relations projects or assignments in support of Health Plan goals and the Home Office.
6. Support Health Plan CEO/COO in the strategic analysis and negotiation of all types of complex Provider contracts.
7. Review financial information and, in collaboration with Medical Finance and other corporate departments, develop effective reimbursement methodologies and strategies to achieve specific contracting and budgetary objectives which are operational and efficient.
8. Monitor local market trends relative to provider contracting, reimbursement and service, make recommendations to modify current processes and assist implementing changes when necessary.
9. Assume responsibility for development, implementation, operation and oversight of provider marketing efforts in collaboration with Sales and Marketing leader.
10. When provider issues become escalated, work with senior management to interact with provider senior administrators, set strategy for issues resolution and monitor progress of issues.
11. Work with staff to identify operational issues and implement projects to promote payment of claims on first submission
12. Supervise the provider network and operations staff to ensure proficiency and efficiency in meeting all Health Plan strategic and operational goals, MJOs and planning goals.
13. Develop and implement strategies to recruit and retain the highest quality staff members.
14. Provide coaching and direction to department directors and other direct report.
15. Other tasks as assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:

- Bachelor?s degree in business administration, healthcare administration or related field

Preferred:

- Master?s degree

Years and Type of Experience Required:

Required:

- Minimum ten (10) years experience in managed care provider relations/provider network administration, with minimum five (5) years in managed care administration.

Preferred:

- Experience with government programs

Specific Technical Skills

Required:

- Strong understanding of the healthcare industry, managed care and provider financing and operations. Experienced in provider network management, provider contract administration and provider network operations. Proven track record in provider contracting and provider relations. Strong project management experience.

Certifications or Licensures

Required:

- Current driver?s license, and at minimum, state required amount of automobile insurance for state where automobile is licensed.

Other:

Required:

- Results oriented self starter who is goal oriented.
- Strong computational and analytical skills related to provider financing and project management.
- Ability to set expectations and provide clear direction to subordinates and support staff or departments being managed.
- Respect for and ability to work well with all levels within the organization and within the provider community.
- Appreciation of cultural diversity and strong sensitivity towards target member population.
- Excellent communication, writing, organizational and project management skills.
- Ability to prioritize and execute multiple complex projects in various markets simultaneously.
- Ability to complete projects/assignments accurately, on-time, on-budget and with a minimum amount of supervision.
- Understanding and appreciation of legal and regulatory environment relative to Provider Relations, provider contracts and provider financing.

PHYSICAL REQUIREMENTS

- Must be able to travel on common carriers, drive an automobile and adhere to AGP?s travel policy.
- Must be able to operate a computer, telephone and other commonly used business-related items.]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Merrifield-AVP-Provider-Relations-Job-VA-22081/886548/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Merrifield-AVP-Provider-Relations-Job-VA-22081/886548/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12264
# Positions: 1
Location: US-GA-Augusta
Search Category: Provider Relations
Type: Regular Full-Time (30+ hours)
Posted Date: 8/31/2010

More information about this job:

Overview:

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

Responsibilities:

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

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

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

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

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

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

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

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

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

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

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

12. Performs other duties and special projects as assigned

Qualifications:

Education Required:

BA/BS degree or equivalent experience

Years and Type of Experience Required: Required:

5+ years of managed care experience, preferably in a Medicaid environment

Specific Technical Skills Required:

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

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

Certifications or Licensures Required: Valid Drivers License

Other Required:

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

PHYSICAL REQUIREMENTS:

Must be able to operate a computer, telephone and fax machine. Must be able to travel locally. Must be able to operate a motor vehicle. Must be able to conduct and participate in meetings]]> Wed, 01 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Augusta-Provider-Relations-Rep-II-GA-30901/923042/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Augusta-Provider-Relations-Rep-II-GA-30901/923042/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11913
# Positions: 1
Location: US-OH-Cincinnati
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

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

Responsibilities:

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

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

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

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

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

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

7. Provides coaching and training to direct reports.

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

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

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

11. Supports earnings improvement initiatives.

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

13. Oversees provider marketing activities.

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

15. Participates in standing meetings as necessary.

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

17. Manages the provider complaint and Provider Relations databases.

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

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

20. Leads provider profiling activities.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:

- BA/BS degree (or equivalent experience)

Years and Type of Experience Required:

Required:

- 5 Years of managed care experience and at least one year of leadership/management experience.

Specific Technical Skills

Required:

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

Certifications or Licensures

Required:

- Must possess a valid drivers license.

Other:

Required:

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

SCOPE INFORMATION

- # Direct Reports: 1-8
- # Indirect Reports:
- Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to travel locally.
- Must be able to operate a motor vehicle.
- Must be able to conduct and participate in meetings]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Cincinnati-Mgr-Provider-Relations-Job-OH-45201/886567/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Cincinnati-Mgr-Provider-Relations-Job-OH-45201/886567/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12314
# Positions: 1
Location: US-FL-Boca Raton
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 9/8/2010

More information about this job:

Overview:

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

Responsibilities:

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

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: ' BA/BS degree or equivalent experience Preferred: Years and Type of Experience Required: Required: ' 5+ years of managed care experience, preferably in a Medicaid environment Preferred: Specific Technical Skills Required: ' Proficiency with Microsoft computer applications including Outlook, Word, and Excel. ' Claims experience/knowledge of medical coding ' Strong telephonic and customer service skills. ' Effective presentation skills. Preferred: ' Experience using Sales force CRM ' Experience using Facets. Certifications or Licensures Required: ' Valid Drivers License Preferred: ' Other: Required: ' Excellent verbal and written communication skills. ' Detail-oriented. ' Ability to handle multiple tasks in a fast-paced environment. ' Must be service oriented and able to identify and resolve problems. ' Appreciation of cultural diversity and sensitivity toward target population. ' Preferred: ' SCOPE INFORMATION # Direct Reports: # Indirect Reports: Budgetary $ Responsibility: PHYSICAL REQUIREMENTS ' Must be able to operate a computer, telephone and fax machine. ' Must be able to travel locally. ' Must be able to operate a motor vehicle. ' Must be able to conduct and participate in meetings]]> Thu, 09 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Boca-Raton-Provider-Relations-Rep-II-Stuart,-Florida-Job-FL-33427/929865/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Boca-Raton-Provider-Relations-Rep-II-Stuart,-Florida-Job-FL-33427/929865/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12003
# Positions: 1
Location: US-MD-Hanover
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/19/2010

More information about this job:

Overview:

Behavioral Health experience desire.

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

Responsibilities:

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

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

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

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

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

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

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

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

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

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

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

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required: BA/BS degree or equivalent experience

Years and Type of Experience Required:

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

Specific Technical Skills

Required:

- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Claims experience/knowledge of medical coding
- Strong telephonic and customer service skills.
- Effective presentation skills.
- Preferred: Experience using Sales force CRM
- Experience using Facets.

Certifications or Licensures

Required:Valid Drivers License

Other:

Required:

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

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

- Must be able to operate a computer.
- Must be able to operate a telephone
- Must be able to travel locally to providers office]]> Fri, 20 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Hanover-Provider-Relations-Rep-II-MD-21075/912466/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Hanover-Provider-Relations-Rep-II-MD-21075/912466/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12219
# Positions: 1
Location: US-TX-San Antonio
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/23/2010

More information about this job:

Overview:

JOB SUMMARY:

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

Responsibilities:

PRIMARY RESPONSIBILITIES:

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

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

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

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

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

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

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

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

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

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

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

12. Performs other duties and special projects as assigned

Qualifications:

EDUCATION AND EXPERIENCE:

Education Required: BA/BS degree or equivalent experience

Years and Type of Experience Required: Required: 5+ years of managed care experience, preferably in a Medicaid environment

Preferred Experience: Claims, contracting, and/or health plan or provider experience.

Specific Technical Skills Required: Proficiency with Microsoft computer applications including Outlook, Word, and Excel. Claims experience/knowledge of medical coding. Strong telephonic and customer service skills. Effective presentation skills. Preferred: Experience using Sales force CRM Experience using Facets.

Certifications or Licensures Required: Valid Drivers License

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

PHYSICAL REQUIREMENTS: Must be able to operate a computer, telephone and fax machine. Must be able to travel locally. Must be able to operate a motor vehicle. Must be able to conduct and participate in meetings]]> Tue, 24 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/San-Antonio-Provider-Relations-Rep-II-TX-78201/915553/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/San-Antonio-Provider-Relations-Rep-II-TX-78201/915553/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12037
# Positions: 1
Location: US-FL-Miami Lakes
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 7/28/2010

More information about this job:

Overview:

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

Responsibilities:

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

Qualifications:

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

More information about this job:

Overview:

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

Responsibilities:

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

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: ' BA/BS degree or equivalent experience Preferred: Years and Type of Experience Required: Required: ' 5+ years of managed care experience, preferably in a Medicaid environment Preferred: Specific Technical Skills Required: ' Proficiency with Microsoft computer applications including Outlook, Word, and Excel. ' Claims experience/knowledge of medical coding ' Strong telephonic and customer service skills. ' Effective presentation skills. Preferred: ' Experience using Sales force CRM ' Experience using Facets. Certifications or Licensures Required: ' Valid Drivers License Preferred: ' Other: Required: ' Excellent verbal and written communication skills. ' Detail-oriented. ' Ability to handle multiple tasks in a fast-paced environment. ' Must be service oriented and able to identify and resolve problems. ' Appreciation of cultural diversity and sensitivity toward target population. ' Preferred: ' SCOPE INFORMATION # Direct Reports: # Indirect Reports: Budgetary $ Responsibility: PHYSICAL REQUIREMENTS ' Must be able to operate a computer, telephone and fax machine. ' Must be able to travel locally. ' Must be able to operate a motor vehicle. ' Must be able to conduct and participate in meetings]]> Tue, 31 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Hanover-Provider-Relations-Rep-II-Job-MD-21075/892050/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Hanover-Provider-Relations-Rep-II-Job-MD-21075/892050/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11655
# Positions: 1
Location: US-TX-Houston
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

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

Responsibilities:

1. Responds to telephonic and written inquiries from providers.

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

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

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

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

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

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

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

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

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

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

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Preferred: BA/BS degree preferred or equivalent experience

Years and Type of Experience Required:

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

Specific Technical Skills

Required:

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

Other

Required:

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

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

- Must be able to operate a computer.
- Must be able to operate a telephone]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Houston-Provider-Relations-Rep-I-Job-TX-77001/886495/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Houston-Provider-Relations-Rep-I-Job-TX-77001/886495/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12315
# Positions: 1
Location: US-NJ-Edison
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 9/8/2010

More information about this job:

Overview:

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

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

Responsibilities:

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

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

12.
Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:

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

Preferred:

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

Years and Type of Experience Required:

Required:

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

Preferred:

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

Specific Technical Skills

Required:

- Knowledge of MS Office Suite (Word and Excel)

Preferred:

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

Certifications or Licensures

Required:

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

Other:

- Ability to work in a team environment as well as independently.
- Excellent organizational and time management skills.
- Excellent communication skills for presentation of information to individuals and groups.
- Self-starter able to work with minimal oversight
- Able to work under pressure and meet deadlines.]]> Thu, 09 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Edison-Provider-Relations-Analyst-Job-NJ-08818/929866/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Edison-Provider-Relations-Analyst-Job-NJ-08818/929866/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11881
# Positions: 1
Location: US-GA-Atlanta
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

Responsible for providing direction and support for regional office, network expansion, network acquisition integration initiatives, marketing, provider relations and other support activities as assigned, typically supporting an entire region. Leads a team of professionals consisting of subordinate Manager(s) and associates to carry out objectives in achieve marketing, growth, servicing and financial goals for an assigned region or market.

Responsibilities:

1. Directs new market network development, network expansion, and network acquisition initiatives as well as basic development and execution of provider network development strategies; manages medical management team and coordinate marketing efforts in conjuction with region headquarters in an entire region.

2. Accountable for subordinate(s) development and performance.

3. Responsible for development of relations and negotiations with providers; provider organizations and community leaders to ensure ongoing servicing and education.

4. Responsible for coordination of interdepartmental network development and implementation processes and manages project plans as well as account management and ongoing servicing and education of provider network.

5. Directs basic new market, provider network and provider research and analyses. Prepares network recommendations and projections.

6. Provides direction and oversight for medical management within the region

7. Travel extensively to accomplish network development, marketing goals and any other assignments.

8. Oversee Community Relations, Marketing, Medical Management and Office Management.

10. Responsible for ensuring quality care, improved outcomes and effective management of healthcare resources. Activities include staffing, policy decisions, operational issues and external relationship development within the region.

9. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

- Bachelor's degree in business administration, healthcare administration or a related field, or minimum of eight (8) years related experience working in managed care, network development and provider relations.

- Experience with project management is preferred.

- An understanding of the healthcare industry, managed care and Provider financing and Medicaid reimbursement is preferred.

- Experience in contracting with hospitals and hospital systems preferred.

- Provider Servicing and Education

- Marketing and Community Relations

- Medical Management

Scope Information:

- Coordinates the region's annual administrative, medical, and capital budget process.

- Manages the regions monthly reporting and review of financials/accruals.

- Oversees a staff of 24 associates with two direct reports.

CERTIFICATION AND LICENSURE:

- Current driver's license, and at minimum, state required amount of automobile insurance for state where automobile is licensed.

Knowledge and Skills

- Ability to successfully interact with community healthcare clinical professionals and business executives nationwide.

- Self starter and /goal oriented.

- Computational and analytical skills.

- Respect for, and ability to work well with all levels within the organization and within the Providerprovider community.

- Appreciation of cultural diversity and strong sensitivity towards the target member population.

- Excellent communication, and organizational and management skills.

- Ability to prioritize and execute multiple complex projects in various markets simultaneously.

- Ability to complete projects/assignments accurately, on-time, on-budget and with moderate supervision.

PHYSICAL REQUIREMENTS

- Must be able to travel on common carriers, drive an automobile and adhere to AMERIGROUP's travel policy.

- Must be able to operate a computer, telephone and other commonly used business-related items]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Atlanta-Director,-Regional-Ops-Job-GA-30301/886552/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Atlanta-Director,-Regional-Ops-Job-GA-30301/886552/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12145
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

Serves as liaison to providers (including physicians, hospitals, and/or ancillary providers) and internal departments at the health plan. Responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers for Medicare product.

These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information. Also may be responsible for recruiting providers to ensure network access and service adequacy.

Responsibilities:

PRIMARY RESPONSIBILITIES:

1. Source and contract with Medicare providers.
2. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force).
3. Ensures that provider relationships with the Plan are positive and productive for both parties.
4. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. . Works with Provider's staff and Amerigroup staff (local and/or corporate) to resolve the issue and monitor recurrence.
5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner.
6. Creates and maintains information required to support the network development process.
7. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.
8. Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures.
9. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames.
10. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.
11. Performs other duties and special projects as assigned

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:

- BA/BS degree or equivalent experience

Years and Type of Experience Required:

Required:

- 5+ years of managed care experience, preferably in a Medicaid or Medicare environment
- Minimum 3+ years Provider Service experience working with Medicare providers
- Minimum 2 years network development and/or provider contracting

Specific Technical Skills

Required:

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

Preferred:

- Experience using Sales force CRM
- Experience using Facets.

Certifications or Licensures

Required:

- Valid Drivers License and Auto Insurance

Other:

Required:

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

PHYSICAL REQUIREMENTS

- Must be able to operate a computer, telephone and fax machine
- Must be able to travel locally
- Must be able to operate a motor vehicle
- Must be able to conduct and participate in meetings]]> Sat, 14 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-Job-TX-75050/908006/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-Job-TX-75050/908006/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12146
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

Serves as an Account Rep to hospitals, free standing facilities, and/or ancillary providers.

Responsible for performing activities designed to establish and maintain positive and productive relationships with Amerigroup network providers for Medicaid and Medicare products. These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information.

Also responsible for recruiting providers to ensure network access and service adequacy. Will perform position requirements in the field or telephonically, as appropriate.

Responsibilities:

1. Source and contract with providers to ensure network adequacy.

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

3. Ensure that provider relationships with the Plan are positive and productive for both parties.

4. Work with Providers to understand issues/concerns. Identify root cause of problems and trends and participates in developing solutions. Work with Provider's staff and Amerigroup staff (local and/or corporate) to resolve the issue and monitor recurrence.

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

6. Analyze provider network for adequacy in addressing members' medical needs and assist in the identification and recruitment of key providers where network gaps or needs exist.

7. Create and maintain information required to support the network development process.

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

9. Provide expertise and assistance relative to provider billing and payment guidelines consistent with Amerigroup policies and procedures.

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

11. Participate in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.

12. Perform other duties and special projects as assigned

Qualifications:

Education

Required:

- BA/BS degree or equivalent experience

Years and Type of Experience Required:

Required:

- 5+ years of managed care experience, preferably in a Medicaid and/or Medicare environment

- 3+ years Network Development and/or Provider Contracting experience

Specific Technical Skills

Required:

- Strong negotiation skills

- Proficiency with Microsoft computer applications including Outlook, Word, and Excel

- Claims experience/knowledge of medical coding

- Strong telephonic and customer service skills

- Effective presentation skills

- Excellent verbal and written communication skills

- Detail-oriented

- Ability to handle multiple tasks in a fast-paced environment

- Must be service oriented and able to identify and resolve problems

- Appreciation of cultural diversity and sensitivity toward target population

Preferred:

- Experience using Sales force CRM

- Experience using Facets

Certifications or Licensures

Required:

- Valid Drivers License and Automobile insurance

PHYSICAL REQUIREMENTS

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

- Must be able to travel locally

- Must be able to operate a motor vehicle

- Must be able to conduct and participate in meetings]]> Sat, 14 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-Job-TX-75050/908007/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-Job-TX-75050/908007/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11813
# Positions: 1
Location: US-TN-Nashville
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

Lead all aspects of Provider Network Management to include provider network strategy, provider contracting, provider relations and operations to support provider service, network development, provider education, and product and market expansions. Responsibilities include the strategic analysis and negotiations for network management, including organizational management, complex contracting, and contracting efforts to support MEIs. Provider Network Management includes all aspects of interaction with claim centers, Business Solutions, HCMS, QI and Service Center Operations. The Provider Relations VP may also work closely with our client or regulatory partners to achieve high level of compliance and customer satisfaction. It is further expected this leadership position is a key part of the health plan leadership team supporting important operational and leadership aspects of the health plan.

Responsibilities:

1. Responsible for managing and improving network management operations to achieve or exceed performance standards/budgets.

2. Leads the development of provider network business plans, strategies and goals.

3. Responsible for hiring, developing, training and retaining high-quality, productive employees.

4. Develops and manages provider contracting efforts and partnerships to achieve quality, cost management, and strategic business development objectives.

5. Assists the CEO/COO with aspects of local and state government relationships, including dealing with regulators as necessary to establish and continue effective working relationships.

6. Effectively represent AGP in interaction and negotiation with the provider network.

7. Collaborate with health plan senior management to identify and align provider contracting efforts with the goals and objectives of the plan and AGP.

8. Lead or assist in the development of Provider network related earnings improvement initiatives.

9. Lead the execution of provider network business plans, strategies and goals.

10. Monitor local market trends relative to Provider contracting, reimbursement and service, make recommendations to modify current processes and lead or assist with implementing changes when necessary.

11. Responsible for managing required regulatory compliance for provider networks.

12. Liaison to home office personnel to ensure that provider credentialing, maintenance and reimbursement is properly maintained.

13. Other Duties as Assigned

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:

- College degree required.

Preferred:

- Advanced degree preferred

Years and Type of Experience Required:

Required:

- Minimum ten (10) years experience in managed care, with minimum eight (8) years in managed care administration, and two (2) years in executive management.

Specific Technical Skills

Required:

- Demonstrated experience with team management and performance improvement.
- Strong understanding of the healthcare industry, managed care and health plan operations

Preferred:

- Experience leading a company or division with a distinct P and L is considered a positive.
- Experience with government programs preferred.
- Knowledge of Medicaid reimbursement methodologies is desired.
- Experience in large, complex negotiations and contracting efforts.
- Documented success in operational management.
- Ability to successfully interact with senior executives of the AGP organization as well as community Healthcare clinical professionals and business executives nationwide.
- Self starter and goal oriented.
- Computational and analytical skills related to Provider contracting and healthcare cost management.
- Ability to establish a strategic vision, set expectations and provide clear direction to individuals or departments being managed.
- Respect for and ability to work well with all levels within the organization and within the Provider community.
- Appreciation of cultural diversity and strong sensitivity towards target member population.
- Excellent communication, organizational and project management skills.
- Ability to prioritize and execute multiple complex projects in various markets simultaneously.
- Ability to complete projects/assignments accurately, on-time, on-budget and with a minimum amount of supervision.
- Understanding and appreciation of legal and regulatory environment relative to Provider Relations.

Certifications or Licensure Required:

- Current driver's license, and at minimum, state required amount of automobile insurance for state where automobile is licensed.

Other

Required:

- Respect for and ability to work well with all levels within the organization and within the Provider community.
- Appreciation of cultural diversity and strong sensitivity towards target member population.
- Excellent communication, organizational and project management skills.

PHYSICAL REQUIREMENTS

- Must be able to travel on common carriers, drive an automobile and adhere to AGP's travel policy.
- Must be able to operate a computer, telephone and other commonly used business-related items]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Nashville-VP-Provider-Relations-Job-TN-37201/886528/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-VP-Provider-Relations-Job-TN-37201/886528/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12088
# Positions: 1
Location: US-FL-Tampa
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 8/4/2010

More information about this job:

Overview:

JOB SUMMARY:

Responsible for the management of staff and activities focused on servicing and contracting of providers with standard contracts. Responsible for managing provider issues resolution, education/orientation, evaluation of network adequacy, recruitment and marketing related to providers. Assists Vice President in assuring that staff is maintaining positive provider relationships, advancing the goals of the Health Plan and promoting consistency with corporate objectives.

Responsibilities:

Manages the Provider Services Team.

Implements and monitors strategic initiatives outlined in the Health Plan?s business plan.

Evaluates the provider network to ensure there is appropriate access for membership.

Develops and implements provider recruitments strategies which support the goals of the Health Plan.

Takes the lead when issues become escalated and interacts with provider administrators as necessary.

Works with Vice President to develop and maintain departmental policies and procedures

Recommends and/or drafts communications relative to Health Plan policies and procedures.

Manages staff to achieve goals for office visits and orientations to ensure that providers receive appropriate education regarding Health Plan protocols.

Manages staff to achieve positive relationships between the Health Plan and its providers through timely issues resolution

Manages staff to achieve earnings improvements and strategic goals.

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

Completes all Provider Relations activities necessary to prepare for the annual State audit.

Oversees the implementation of contracts including monitoring the completion of the credentialing and data entry functions.

Monitors the network to assure the Health Plan is meeting State requirements.

Drafts copy for provider bulletins regarding billing guidelines when necessary.

Assures community outreach activities are appropriate and DOEA approved if applicable.

Interfaces with all other departments to ensure accurate and appropriate configuration of contracts, database maintenance, provider recoveries, reimbursement rates, benefits configuration, project management, etc.

Participates in standing meetings regarding provider reimbursement and operational issues, network development activities, and other issues as necessary

Represents the Provider Relations Department at senior management meetings when necessary.

Ensures that inventory of provider communication materials is maintained.

Monitors provider concerns and issues, and provides feedback to appropriate associates/departments of Provider Relations. Assists in developing and communicating the appropriate response to providers.

Develops and implements action plans regarding provider satisfaction results.

Completes other duties and projects as assigned.

Qualifications:

Required:

- BA/BS degree (or equivalent experience).

Years and Type of Experience Required:

Required:

- 7 years experience in managed healthcare environment, provider relations or network management and at least 3 years of leadership/management experience.

Preferred:

Specific Technical Skills

Required:

- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Knowledge of provider reimbursement methodologies, claims processing, billing practices, and fee schedules.
- Familiarity with provider organizational arrangements; IPA, PHO, Group Practice, etc?
- Strong telephonic and customer service skills.
- Effective presentation skills.

Certifications or Licensures

Required:

- Valid driver?s license

Other:

Required:

- Leadership skills, ability to take charge when necessary
- Supervisory experience.
- Knowledge of provider compensation and capitation issues.
- Above average negotiation skills.
- Excellent communications and presentations skills.
- Strong analytical abilities.
- Ability to complete multiple projects and to meet deadlines.
- Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION

# Direct Reports: 1 - 4

# Indirect Reports: 1-15

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS:

- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to conduct and participate in meetings.
- Must be able to travel locally.
- Must be able to operate a motor vehicle.
- Must be able to travel on common carrier and adhere to AMERIGROUP?s travel policies.]]> Sun, 05 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Tampa-Director-Provider-Relations-Job-FL-33601/895991/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Tampa-Director-Provider-Relations-Job-FL-33601/895991/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11831
# Positions: 1
Location: US-VA-Virginia Beach
Search Category: Information Technology
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

Responsibilities:

- Assists with the creation of Amerigroup corporate network strategy including the planning, design, and integration of telecommunication infrastructure systems
- Provides strategic planning to ensure telecommunication capacity meets current and future requirements and develops the methodologies for system analysis, installation and support
- Functions as an expert-level technical advisor with advanced knowledge and experience in the area of design and implementation of local and wide area telecommunications, and related hardware/software solutions
- Performs complex technical analysis of software, hardware, and telecommunication systems for integration in the corporation telecommunications network
- Develops technical standards, and assists in the planning of corporate solutions which integrate with the corporate telecommunications network
- Provides telecommunications operations support to include planning based on performance analysis
- Provides integrated team support and maintenance of systems and telecommunications hardware and software
- Performs analysis of vendor products to determine best fit for company needs and assists in the presentation of information to management for purchase decisions
- Ensures telecommunications security is strengthened by offering solutions based on testing of current technologies, and future requirements
- Provides complex problem resolution based on real-time analysis and data collection
- Leads the evaluation of vendor products for future purchase
- Leads initiatives with regard to product testing and integration
- Provides leadership and training for ITS Telecommunications personnel
- Act as the primary point of contact for National Customer Center

Qualifications:

- Bachelor?s degree in Computer Science or related field. Equivalent experience acceptable in lieu of a degree(s)
- Requires a minimum of 8 years related work experience
- 2-3 years of hands-on experience administration
- Expert knowledge of Avaya systems and related hardware and telecommunications software
- Expert knowledge of Call Center technologies configuration, maintenance and troubleshooting.
- Expert knowledge of Unified communications technologies
- Expert knowledge of telecommunications design related to various telecommunications hardware and software
- Expert knowledge of Avaya telecommunications network hardware and software
- Expert intra-discipline knowledge of security ?best practices? and tools
- Expert solution design skills
- Excellent task delegation and project management skills
- Excellent verbal and written communication skills.
- Excellent analytical, organizational, and time management skills.
- Customer focused.
- Self motivated.
- Ability to react quickly and positively to changes while exercising sound judgment.]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Virginia-Beach-Avaya-Telecom-Architect-Princ-I-Job-VA-23450/886538/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Virginia-Beach-Avaya-Telecom-Architect-Princ-I-Job-VA-23450/886538/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11973
# Positions: 1
Location: US-TN-Nashville
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

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

Responsibilities:

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

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

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

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

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

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

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

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

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

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

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

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

13. Supports new hire and refresher training of associates.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required: High School Diploma

Preferred: College Degree

Years and Type of Experience Required:

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

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

Technical Skills

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

Preferred:

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

Other

Required:

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

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

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

- Must be able to operate a computer.
- Must be able to operate a telephone]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Nashville-Provider-Information-Spec-III-Job-TN-37201/886601/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Provider-Information-Spec-III-Job-TN-37201/886601/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12061
# Positions: 1
Location: US-NM-Albuquerque
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 8/2/2010

More information about this job:

Overview:

JOB SUMMARY:

Serves as liaison to providers (including physicians, hospitals, and/or ancillary providers) and internal departments at the health plan.

Responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers for Medicaid and Medicare products.

These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information.

Also may be responsible for recruiting providers to ensure network access and service adequacy.

Provides training, guidance and assistance to Provider Relations Representatives I to support their skill development and successful completion of assignments.

May perform position requirements in the field or telephonically, as appropriate.

More emphasis is placed on field work at the Rep Level II.

Responsibilities:

PRIMARY RESPONSIBILITIES:

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

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

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

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

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

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

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

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

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

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

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

12. Performs other duties and special projects as assigned

Qualifications:

EDUCATION AND EXPERIENCE:

Education Required: BA/BS degree or equivalent experience

Years and Type of Experience Required: Required: 5+ years of managed care experience, preferably in a Medicaid environment

Specific Technical Skills Required:

Proficiency with Microsoft computer applications including Outlook, Word, and Excel.

Claims experience/knowledge of medical coding

Strong telephonic and customer service skills.

Effective presentation skills.

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

Certifications or Licensures Required: Valid Drivers License

Other:

Required:

Excellent verbal and written communication skills.

Detail-oriented.

Ability to handle multiple tasks in a fast-paced environment.

Must be service oriented and able to identify and resolve problems.

Appreciation of cultural diversity and sensitivity toward target population.

SCOPE INFORMATION

# Direct Reports:

# Indirect Reports:

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

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

Must be able to travel locally.

Must be able to operate a motor vehicle.

Must be able to conduct and participate in meetings]]> Fri, 03 Sep 2010 00:09:00 http://www.amerigroup-jobs.com/job/Albuquerque-Provider-Relations-Rep-II-Job-NM-87101/893090/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Albuquerque-Provider-Relations-Rep-II-Job-NM-87101/893090/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11728
# Positions: 1
Location: US-MD-Hanover
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

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

Responsibilities:

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

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

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

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

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

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

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

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

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

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

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

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required: BA/BS degree or equivalent experience

Years and Type of Experience Required:

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

Specific Technical Skills

Required:

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

Preferred:

- Experience using Sales force CRM
- Experience using Facets.

Certifications or Licensures

Required: Valid Drivers License

Other:

Required:

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

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

- Must be able to operate a computer, telephone and fax machine.
- Must be able to travel locally.
- Must be able to operate a motor vehicle.
- Must be able to conduct and participate in meetings]]> Mon, 23 Aug 2010 00:08:00 http://www.amerigroup-jobs.com/job/Hanover-Provider-Relations-Representative-II-Job-MD-21075/886505/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Hanover-Provider-Relations-Representative-II-Job-MD-21075/886505/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12181
# Positions: 1
Location: US-VA-Merrifield
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 8/18/2010

More information about this job:

Overview:

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

Responsibilities:

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

Qualifications:

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