Provider Relations Rep I (Bilingual Spanish) Job

Provider Relations Rep I (Bilingual Spanish)Job ID: 2011 16541 # Positions: 1Location: US TX Houston Search Category: Customer ServiceType: Regular Full Time (30+ hours) Posted Date: 1/23/2012More information about this job:Summary: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. May perform position requirements in the field or telephonically, as appropriate.Responsibilities: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. 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. 5. 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. 6. Creates and maintains information required to support the network development process. 7. Conducts onsite provider education forums, orientations, and provider servicing visits to ensure providers are well acquainted with AMERIGROUP benefits, policies, and procedures. 8. Provides expertise and assistance with guidelines relative to provider billing and payment. 9. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled. 10. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities. 11. Participates in earnings improvement opportunities, as appropriate and achieving strategic objectives relating to the Provider network. 12. Other duties as assignedQualifications:EDUCATION AND EXPERIENCE: Education Required: Preferred: BA/BS degree preferred or equivalent experience Years and Type of Experience Required: Required: Preferred: 3 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 Item Measure # Direct Reports # Indirect Reports Budgetary $ Responsibility PHYSICAL REQUIREMENTS Must be able to operate a computer, telephone and fax machine. BILINGUAL: Spanish PreferredermCS