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Description
Job Title:
AVP Medicare Part D Program Operations - Pharmacy
Job ID:
10555
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY:
The Associate Vice President, Medicare Operations and Program Management will be responsible for implementation and ongoing support of the Medicare Special Needs plan operational model. This individual will lead the implementation (e.g. people, process, technology development) of the business model and target environment. The incumbent of this position will provide the skills and leadership ability that ensure successful operations through matrix management and oversight of AMERIGROUP operations designated service teams. Working with the Vice President, Medicare and Financial Operations, this position will ensure established rules, policies and procedures are implemented in such a way the Medicare SNP operations are successful, efficient, auditable, and replicable.
PRIMARY RESPONSIBILITIES:
1.Ensure success of the Medicare Special Needs Plan operation model through matrix management of designated service units within each operational area. Work with functional managers to negotiate resources, process changes and appropriate training.
2.Develop, implement and manage operational processes that will ensure maximization of Medicare Part A, B and D reimbursement methodology. Processes will include effective member/premium reconciliation and accurate and timely Part A, B and D encounter processing and oversight to proactive processes that monitors the accuracy of provider claims submissions and provider education.
3.Develop and monitor management reports which indicate expected services levels, data/processing quality and production volumes of all Medicare operational components.
4.Lead the successful implementation of new Medicare expansion areas, processes and products.
5.Contribute to knowledge sharing and understanding of Medicare Special Needs Plans by creating and providing presentations and training documents related to Medicare operations.
6.Contribute to the growth of Medicare Special Need plans and products by participation in developing/modifying business processes and target environment as needed.
7.Implement effective and appropriate program communications plan. Monitor all CMS systems, guidance and notices. Lead initiatives to communicate changes and modify processes and documentation as needed
8.Ensure successful internal and external audits by working with operational teams to become SOX compliant. Ensure adherence to appropriate processes, methodologies, policies and procedures.
9.Work with Vice President, Medicare and Financial Operations to identify and drive resolution to any issues that may hinder program success.
10. Provide operational guidance for processes which straddle Medicare and Medicaid programs.
EDUCATION AND EXPERIENCE:
Education
Required:
Bachelor's Degree or equivalent experience in Business or Health Care Management.
Years and Type of Experience Required: Required:
Minimum of five years experience in Health Care industry required.
Minimum seven years progressively responsible experience managing and supervising operational processes, required.
In depth knowledge of the Medicare processes and regulatory requirements
Prior experience leading teams dependent upon strong negotiation and management skills.
Prior experience working in health care operations.
Other equired:
Exceptional leadership capabilities with a strong work ethic, and the ability to keep pace with Amerigroup' growing pace.
A dedicated team builder and player who is capable of operating effectively with a minimum of direction, and who enjoys interaction with all levels within an organization.
A resourceful self-starter with a high level of intelligence and energy.
Effective presenter and problem solver.
PHYSICAL REQUIREMENTS
Able to conduct and facilitate meetings
Able to operate a computer.
Able to travel upon request.
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:
610541A2
Posted / Updated:
11/21/2009 2:52:27 AM
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