Medical Management, Division Manager

Department: Compass Medical Management
Shift: Exempt
Salary: Commensurate upon experience

Increases net revenue of the Compass profit center by increasing revenue, decreasing expenses, providing supervision, and supporting the clinical and administrative duties. Provides clinical oversight and advice to AmeriBen.

Key Result Areas

Essential

Grows top line revenue by recognizing opportunities, strategizing, pricing, packaging, identifying products/services, promoting, identifying/coordinating with channels of distribution, creating/giving sales presentations, etc.
Reduces expenses while delivering accuracy, customer service, and timely turnaround (ACT) by ensuring the right amount of staff, equipment, training, and processes are available.
Supervises nurses (case management, precertification and disease management) and assistants including hiring, firing, performance evaluations, training, work allocations and problem resolution.
Provides oversight and support to Compass team.
Compiles and prepares educational and marketing materials as necessary.
Reviews and evaluates the quality and appropriateness of Compass services.
Oversees all operational and administrative processes to ensure Compass Best Practices, compliance with industry standards, licensing and accreditation and certification boards.
Oversees the maintenance of Compass records for accuracy and maintenance of patient confidentiality.
Revises and/or compiles information for educational and marketing materials as needed.
Conducts weekly supervision meetings.
Prepares periodic reports on activities as required.
Performs other duties as assigned or needed.

Minimum Qualifications

Demonstrated entrepreneurial experience (creating top line growth and bottom line results).
Demonstrated sales and marketing abilities.
Must have current RN license and CCM certification, HCQM preferred.
Minimum of five years Utilization Management experience.
Disease management and wellness experience.
Minimum of two years supervisory experience.
Ability to work efficiently, be organized, perform multi-tasking, prioritize tasks and meet tight deadlines.
Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self.

Customer Care Representative I

Department: Customer Care Services
Supervisor: Cust. Care Sr, Lead
Shift: Monday - Friday, 7am-6pm
8 Hour Shift May Vary
Posting Expires: 8/13/10
Pay Range: $11.45 - $13.45

As a Customer Care Representative, you answer or direct incoming calls and respond to customer inquiries regarding claims benefits which will involve researching and resolving problems for customers.

Key Result Areas:

Answers incoming telephone calls
Responds to claims questions from customers regarding benefits, eligibility and coverage. Explains policies to customers
Researches customer inquiries, completes the follow-up and paper work
Research calls returned within 48 hour turnaround time or as promised
Must meet 5 day turnaround time with Call Tracking
Must take an average of 60 calls per day after training has been completed
Performs other duties as assigned or needed.

Minimum Qualifications:

High school education or equivalent
Minimum one year of customer service experience
Knowledge of medical and dental terminology a plus
Excellent customer service attitude and professionalism
Team and goal oriented
Exceptional interpersonal and problem solving skills
Good organizational, written and verbal communication skills
Types 45 wpm, 10-key and computer knowledge
Good knowledge of Microsoft Office software (Word, Excel, Power Point, and Outlook)
Ability to organize, work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines
Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self

Once there they will need to reference AmeriBen/IEC Group and request the appropriate test for the position they are applying.

When going to the Idaho Dept of Labor, tell the consultant that you must take the "Call center Telephone Etiquette` test.

EXTERNAL APPLICANTS WILL NEED TO KEEP A COPY OF THE RESULTS TO SEND IN WITH THE APPLICATION AND RESUME.

Appeals Supervisor

Department: Appeals
Reports to: Customer Care/Prov. Rel. Supervisor
Shift: Exempt
Pay Range: $36,857.60 - $44,228.19
Pay Grade: S3
Close Date: August 6, 2010

Supervise team of appeals clerks to ensure responses to written appeals are completed timely and accurately in compliance with applicable laws and internal procedures.

Key Result Areas

Essential

Supervise team of appeals clerks and conduct hiring, performance reviews, performance improvement plans, disciplinary action and recommend compensation adjustments.
Monitor the appeals process for all group health plan appeals including ERISA governed appeals and state-regulated group health plan appeals.
Interact with attorneys, paralegals and other representatives regarding pending appeals.
Research appeals related issues including plan language and legal requirements.
Based upon the volume of appeals, assist the appeals team with the adjudication of claims appeals.
Draft responses to escalated appeals, departments of insurance complaints, and correspondence from attorneys.

Additional

Perform other related duties as assigned or needed.

Minimum Qualifications

Bachelor's degree or 3-5 years of industry experience preferred.
Prior supervisory experience and proven ability to maintain a positive team environment and lead others within the team to accomplish goals
Exceptional customer service, problem solving, communication (written & verbal) and organizational skills
Ability to maintain excellent working relationships with all departments
Ability to handle pressure situations, personnel, and management
Ability to delegate
Ability to maintain confidentiality.
Ability to work efficiently in a fast paced environment, perform multi-tasking, prioritize tasks, and meet tight deadlines
Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self

Typical Minimum Standards

Adherence to the values and purpose of AmeriBen/IEC Group
Completes all projects in a timely and accurate manner

Claims Processor

Department: Claims
Supervisor: Claims Sup.
Shift: Days
Posting Expires: 8/13/10
Pay Range: $11.45 - $13.45
Pay Grade: H-6

Key Result Areas

Reviewing and approving inbound medical claims
Determine appropriate payouts based on benefit plan provisions
Process call trackings and return pends
Maintain a production level of at least 25 claims per hour with an accuracy of 99% for financial, 98% for payment, and 97% for procedure after training

Minimum Qualifications

High school graduate or equivalent
Minimum of 1-2 years prior medical claims processing or medical billing experience
Knowledge of medical and dental terminology
Exhibit good problem solving, analytical and excellent correspondence skills
Ability to utilize ten key by touch and type 45 wpm.

All applicants must complete pre-employment testing administered by the Idaho Department of Labor (IDL). For external applicants and referrals, tests will be administered in the following IDL offices
- Boise office @ 219 W. Main St., Boise
- Meridian @ 205 # Watertower Lane, Meridian
- Canyon County office @ 4514 Thomas Jefferson St., Caldwell
When going to the Idaho Dept of Labor, tell the consultant that you must take the "Medical Claims Processing" test.

EXTERNAL APPLICANTS WILL NEED TO KEEP A COPY OF THE RESULTS TO SEND IN WITH THE APPLICATION AND RESUME.