Description
Job Title:
Director Service Operations Account Mgmt
Job ID:
10552
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY:
Works independently to advance AMERIGROUP's strategic imperatives as the primary link between the Customer Service Organization and the various Health Plan and State business partners. Responsible for understanding the functional areas of the organization and how the functional areas interrelate while building strong working relationships with peers and senior management both at the Health Plans and within the Customer Service Organization support areas. Demonstrates a high level of flexibility by managing multiple projects across Health Plan's based on strategic priorities. Responsible for identifying and prioritizing opportunities for improvement in the areas of efficiency and effectiveness.
PRIMARY RESPONSIBILITIES:
1.Partners and supports management across the Customer Service Organization on assigned projects ensuring company goals and initiatives are met.
2.Participates in process improvement initiatives and facilitates collaborative effort between support areas and Health Plan Operations for implementation.
3.Collaborates with Health Plan Operations and support areas to ensure appropriate key operational indicators are in place for monitoring and analysis.
4.Identifies and maintains inventory of issues and defects related to the Customer Service Organization and routinely provides inventory reports for awareness and resolution.
5.Coordinates and facilitates cross-functional issue resolution work sessions emphasizing issue identification, assignment, global correction and root-cause eradication.
6.Works with Customer Service Organization departments to resolve operational and ITS issues including, but not limited to enrollment, benefit configuration, call metrics, authorizations, pended claims, CAMP, provider data, appeals, encounters, provider contracting, customer service, regulatory reporting, technical interfaces, vendors and Facets related issues.
7.Applies system hierarchy and configuration knowledge to resolve moderate to complex business issues, identify alternatives, determine impact, and recommend optimal solutions.
8.Partners with Health Plans and Regulatory to support business/technical requirement changes.
9.Facilitates cross-functional review sessions as appropriate when at risk issues develop pertaining to state contract compliance.
10.Functions as primary contact for state technical business partners and coordinates cross-functional participation in requirement changes and issue resolution.
11.Maintains awareness of strategic initiatives to ensure priority alignment and promotes Health Plan communication and collaboration.
12.Recognizes and utilizes appropriate channels for communication, encourages two-way communication with Health Plan and Customer Service Organization staff to improve efficiency and enhance job performance.
13.Other duties as assigned.
EDUCATION AND EXPERIENCE:
Education Required:
Bachelor's degree in Business Administration, Management Information Systems, Health Care or a related discipline. Equivalent experience is acceptable in lieu of a degree(s).
Preferred:
Master's degree preferred.
Years and Type of Experience Required: Required:
A minimum of 7 years relevant work experience and at least 3 years of leadership/management experience.
Project management or leadership experience in a medium to large size business environment.
Preferred:
A minimum of 10 years relevant work experience.
Specific Technical Skills Required:
Demonstrate advanced proficiency with all applicable company supported software applications including performing complex queries.
Demonstrated knowledge of claims payment system architecture and configuration.
Demonstrates mastery of process improvement methodology (i.e., Six Sigma certification) in appropriate timeframe as directed by management.
Preferred:
FACETS operating system and data model experience.
Certifications or Licensures Required:
N/A
Preferred:
Green Belt quality certification
Other Required:
Excellent analytical, organizational, problem-solving, and communication skills.
Ability to demonstrate political sensitivity and to work effectively with senior level management as well as with multi-disciplinary teams across department lines.
Demonstrated ability to apply knowledge of managed care operations and information technology for problem solving and business decision making.
Ability to develop creative strategies and tap the creative potential of individuals and groups.
Strong leadership, coaching, and staff development skills.
Ability to continually assess needs and facilitate the implementation of measures to ensure customer expectations are met or exceeded.
Ability to motivate others, provides innovative ideas and solutions, and promotes the organization vision for improvement.
Ability to develop and manage multiple projects with minimal direction and supervision.
Conflict resolution/mediation experience.
Preferred:
Experience with change management.
SCOPE INFORMATION
# Direct Reports: 0-12
# Indirect Reports: 0-25
Budgetary $ Responsibility: 0-$5m
PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
Ability to communicate both in person and/or by telephone.
Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
Equal Employment Opportunity
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.
Details:
Job Id:
610539A2
Annual Salary:
Position Type:
Education Level:
No Selection
Experience Level:
No selection
Posted:
10/24/2009 2:31:26 AM
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