http://www.amerigroup-jobs.com/go/Fort-Worth-Medical-Billing-Jobs/169142/ View Fort Worth Medical Billing Jobs at Amerigroup Thu, 09 Sep 2010 20:09:32 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/go/Fort-Worth-Medical-Billing-Jobs/169142/ 720
Job ID: 2010-12200
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/19/2010

More information about this job:

Overview:

JOB SUMMARY:

Builds and supports our Medicare provider network.

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. 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 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]]> http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-TX-75050/914224/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-TX-75050/914224/?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]]> 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]]> 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: 2010-12151
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

The HCMS manager is responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services.

Responsibilities:

1. Manages and oversees team responsible in case finding and coordinating those cases that involve comorbid conditions and need to be part of the case management/disease management track.

2. Manages and evaluates team's performance and ensure adherence to department's standards

3. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.

4. Works with providers to establish short and long term goals that meet the member's need, functional abilities and referral sources requirements.

5. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.

6. Coordinates the identifications of members with potential for high risk complications.

7. Assesses members present level of physical/mental impairment utilizing defined criteria and methodology.

8. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.

9. Review benefit systems and cost benefit analysis.

10. Evaluates the member against level of care criteria.

11. Demonstrates knowledge of utilization management targets.

12. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.

13. Requests direction from Medical Director on complex healthcare issues.

14. Maintains member confidentiality and respect of the patient bill of rights.

Qualifications:

EDUCATION AND EXPERIENCE:

Education Required: Bachelors Degree, or equivalent work experience

Preferred: MSN, MPH, MPA, or MSW or related or MBA with Health Care Concentration

Years and Type of Experience Required: Required: Five years experience in health Care Management and at least one year of leadership/management experience.

Knowledge and Technical Skills Required:

' Knowledge of community resources

' Basic Computer skills to include Microsoft Word and Excel

' Ability to provide supervision to multidisciplinary team

' Strong decision making skills ' Ability to provide services in an environment that involves multiple health, mental health and substance abuse care systems.

' Ability to interact with all relevant components of the health and behavioral health care systems

' Self starter with the ability to handle multiple projects at one time.

Certifications or Licensure Required: RN, or PA, or LSW, or LPC, or LMHC

Preferred: Certified Case Manager

SCOPE INFORMATION Item Measure

' # Direct Reports 2-10 (or individual contributor in a coaching/training capacity within the department)

PHYSICAL REQUIREMENTS

' Able to operate a computer

' Able to operate a telephone]]> http://www.amerigroup-jobs.com/job/Grand-Prairie-Manager-Health-Care-Management-Services-Job-TX-75050/908012/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Manager-Health-Care-Management-Services-Job-TX-75050/908012/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS