Amerigroup was founded in 1994 to respond to the growing need for private-sector partners in states managing healthcare programs for lower-income families and people with disabilities. Since its inception, Amerigroup has been a proven leader in meeting the states' objectives of providing accountability and improving access to healthcare while still controlling care costs. Today, Amerigroup is the largest publicly-traded company focused exclusively on meeting the needs of those enrolled in publicly-funded healthcare programs, such as, Medicaid and Medicare. Through its subsidiaries, Amerigroup Corporation serves approximately 1.7 million people in Florida, Georgia, Maryland, New Jersey, New Mexico, New York, Nevada, Ohio, South Carolina, Tennessee, Texas, and Virginia.

**FIVE YEARS OF MEDICARE CLAIMS PROCESSING EXPERIENCE REQUIRED AND ONE YEAR LEADERSHIP/MANAGEMENT EXPERIENCE**



Grade: 19



JOB SUMMARY:

Provides leadership and day-to-day direction for production-related claims activities for Dedicated Service Unit (Medicare), to include: claims, inventory control, management reporting and management and development of staff.



PRIMARY RESPONSIBILITIES:



1. Evaluating and management of all daily activities and issues involving the accurate and timely processing of claims.



2. Manages the day-to-day activities of assigned associates; manages and monitors inventory control; supervises staff creating development plans for associates, providing timely and effective feedback, and develops corrective action plans when performance is below standard documenting any and all performance-related activity.



3. Interaction with other departments to resolve problem situations raised through member or provider communication.



4. Ensure the preparation and analysis of all standard claim reports as requested.



5. Monitor claims processing activities to ensure that the organization's service, quality, productivity and financial standards or goals are achieved. Builds partnerships with other teams to drive results..



6. Develops policies and procedures and processes to ensure the successful implementation of new or revised contracts in accordance with Federal, State and other regulatory agency requirements.



7. Serves as the department expert for the Health Plan in the areas of provider billing, provider reimbursement and benefits. Will interpret contract language and rates and coordinate with other internal customers to ensure the accuracy of system configuration and claims processing.



8. Ensure all statistical performance reports are generated within all required time frames.



9. Ensures ongoing communication with internal/external customers.



10. Represents AMERIGROUP in provider meetings and audits.

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11. Sets goals to meet and exceed customer expectations.



12. Plans capacity load for assigned markets to effectively and appropriately staff for claim volume.



13. Balance load with other teams to maintain results and meet all service levels.



14. Implements and plans process improvements.



15. Provides suggestions and develops methods to increase/improve productivity and quality results.



16. Partners with human Resources to resolve issues, improve process and provide positive experience for the staff.



17. Other duties as assigned.





EDUCATION AND EXPERIENCE:



Education

Required:

* Bachelors degree or equivalent experience



Years and Type of Experience

Required:

* Minimum of 5 years relevant Medicare Claims Processing experience with at least one year leadership/management experience, or

* (Internal) Demonstrated proficiency and 1-2 years experience as an AMERIGROUP Supervisor



Specific Technical Skills

Required:

* Intermediate level MS Office skills.

* Understanding of medical terminology claims coding, and standard claims forms used for physician and hospital billings, inventory control, trending and reporting

* Strong Analytical/Problem Solving Skills.

* Knowledge of state guidelines and regulations applicable to Medicare.

Preferred:

* Understand core systems and processes of assigned area.



Certifications or Licensures

Required:

* (Internal Applicants) who do not possess a college degree, must have successfully completed the Element KTraining Courses in the Business Writing Series prior to selection, or within their 90 day introductory period.

Preferred:

* (Internal Applicants) Element K Training Courses: Essentials of Management, Coaching & Team Building, Personal Communications, Peer Today, Boss Tomorrow.



Other:

Required:

* Intermediate to advanced level understanding of expense management and cost controls.

* Possess strong communication skills to include the ability to represent AMERIGROUP in provider meetings and audits.

* Conflict management skills.

* Possess strong interpersonal skills to manage, develop, and retain staff

* Demonstrates initiative; is proactive in problem resolution; ability to multitask.

* Able to work independently and use reference material to resolve claims related questions.

Preferred:

* Understanding of the interrelationships between Amerigroup departments to be able to communicate and interact effectively with associates and external customers.





SCOPE INFORMATION



# Direct Reports: 25-30

# Indirect Reports:

Budgetary $ Responsibility: Authority to approve claims up to $200,000



PHYSICAL REQUIREMENTS:

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



* Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.

* Ability to communicate both in person and/or by telephone.

* Must be able to conduct, actively participate and facilitate meetings.

In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.



AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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