Government Administration Manager - Long Beach, United States - Advanced Medical Management, Inc.

Advanced Medical Management, Inc.
Advanced Medical Management, Inc.
Verified Company
Long Beach, United States

3 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

TITLE

GOVERNMENT ADMINISTRATION MANAGER
***Reports to AMM Director of Administration. Individual is responsible for overseeing all aspects of AMM operations utilized to provide Fiscal Intermediary services to assigned Government contracts, Fiscal Intermediary clients, including maintaining communication with client leadership, resolving problems, and acting as the interface between AMM departments to provide quality services to the client per our agreement with them.


RESPONSIBILITIES-DUTIES
Primary liaison to AMM Government Clients.

Develops and trains all department staff.


Schedules and conducts Client meetings, which may include Joint Operations Meetings, QA/UR Committee meetings, Credentialing Committee meetings, and other meetings as assigned or needed.

Develops agenda items with Client leadership, AMM Executives and AMM Department Managers. Keeps minutes of meetings, maintains action items and monitors follow-up.

Provides required and ad hoc reports to the client which includes auditing reports for accuracy. Leads special projects as assigned or required.

Ensure compliance with all applicable state and federal guidelines and laws. Ensures compliance with the rules and regulations as set forth in the

Work closely with AMM department managers to assure that all Client services are performed with the highest quality outcomes.

Work closely with AMM executives and make strategic planning recommendations that will improve quality and efficiency.

Work closely with the Eligibility Manager to ensure the receipt and accurate loading of eligible members into AMM systems.

Work closely with Director of Care Management to monitor utilization of health care services and overall quality of care.


Work closely with Finance Director to assist with the oversight of funding and disbursements, including payments from agencies, capitation and claims payments to physicians, hospitals, and other providers of care.


Work closely with Contracts Manager and configuration department to maintain accurate contracting information in AMM systems including rates paid to providers of care including annual updates to fee schedules.


Work closely with Provider Network and IT to maintain accurate provider information in AMM systems including any provider registration requirements.


Work closely with EDI manager to oversee all Electronic Data Interchange, including receipt of claims files, and accurate reporting of data to Clients.

Work closely with Claims Supervisor regarding grievances, appeals, and other reimbursement issues.


Work closely with Claims Manager to ensure accurate and timely processing of claims, correct payment per provider contracts and client guidelines.

Research and resolve reimbursement issues as well as provider utilization and payment trending.


At the direction of the Clients, work closely with Contract Manager for the initiation and execution of all provider and ancillary agreements.


EDUCATION & EXPERIENCE REQUIREMENTS

  • Bachelor degree in Health Care Administration or Public Health Administration from an accredited university.
  • Six years experience in managed health care adminstration
  • Knowledge of applicable state and federal managed care laws and guidelines (AB 1455, Accountable Care Act, HIPAA, Stark, etc.).
  • Experience negotiating physician, provider and hospital agreements preferred.
  • Ability to manage all aspects of business operations, and effectively manage personnel and various projects within time constraints.
  • Effectively interface and successfully cultivate relationships with various business partners; including hospitals and health care providers.
  • Attention to detail and take ownership of assigned tasks.
  • Valid driver's license and/or dependable transportation to work off and onsite is necessary.
  • Must be computer literate and knowledgeable in Microsoft Office, with understanding of EMR systems, and IPA management software.

Pay:
$85, $90,000.00 per year


Benefits:


  • 401(k)
  • Dental insurance
  • Health insurance
  • Paid time off
  • Vision insurance

Schedule:

  • 8 hour shift
  • Monday to Friday

Ability to Relocate:

  • Long Beach, CA 90815: Relocate before starting work (required)

Work Location:
In person
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