Provider Relations Representative II

JOB SUMMARY:
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. Also provides training, guidance and assistance to Provider Relations Representatives I to assist them in the successful completion of their assignments.  May perform position requirements in the field or telephonically, as appropriate.


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

5. 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.

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

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

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

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

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


13. Other duties as assigned


EDUCATION AND EXPERIENCE:
Education
Required:
Preferred:  BA/BS  degree preferred or equivalent experience
Years and Type of Experience 
Required: 3+ years of managed care experience interacting with and providing support to the provider network
Preferred:  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
Preferred: 
Certifications or Licensure
Required:
Preferred: 
Other
Required: Excellent verbal and written communication skills
  Detail-oriented
  Ability to handle multiple tasks
Preferred: 

SCOPE INFORMATION

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PHYSICAL REQUIREMENTS
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Please apply online at: www.amerigroupcorp.com