Job Description:

 Vantage Health Plan, Inc. is a distinguished local Health Insurance Company that offers competitive salaries and great benefits. Benefits include: Health, Dental, Life, Long Term Disability, Paid Time Off, 401(k), as well as corporate rates at area health clubs.

We are currently looking for an IT Network Administrator for our IT Department.

 The Network Administrator I is responsible for implementing highly complex network infrastructure projects involving the design, analysis, maintenance, and implementation of network equipment.  The Network Administrator I will adjust, monitor, troubleshoot, and be responsible for the overall operation of the network devices on-site and remote locations for Vantage Health Plan. 
Essential Duties & Responsibilities:
• Participates in the day-to-day operation of computer networks including hardware/software support, training, and special projects; plans, designs and implements data connectivity for local area network (LAN) and wide area network (WAN) systems
• Participates in researching network and server hardware and software for complex networks
• Monitors usage to ensure security of data and access privileges; installs, supports and maintains network servers and appliances; establishes and maintains user accounts, profiles, file sharing, access privileges and security; performs daily server tape backups
• Researches, analyses, monitors, troubleshoots and resolves simple server or data network problems. Brings possible solutions to senior network administrators for approval
• Researches and evaluates new technologies related to computer networking
• Coordinates with vendors and clients for hardware/software purchases, product services and support
• Keeps current regarding new hardware/software products for system enhancements
• Coordinates network policies, procedures and standards and enforces security procedures
• Ensures that computer software and applications adhere to the organizational plan
• Configures networks to ensure their smooth and reliable operation for fulfilling business objectives and processes
• Participates in managing all network security solution
• Ensures network connectivity of all servers, workstations, telephony equipment, fax machines, and other network appliances
• Practices network asset management, including maintenance of network component inventory and related documentation and technical specifications information
• Performs security audits and network recovery

Marginal Duties:
• Assists in maintaining the network user documentation including hardware/software applications, support logs and other related information
• Assists in installing, configuring, and maintaining system hardware and software as needed
• Assists in network support, and archiving procedures
• May troubleshoot network logs and tracks of the nature and resolution of problems
• Helps to establishes and maintains user e-mail accounts; provides e-mail training and software support; provides e-mail documentation and updates user manual as needed
• Other duties as assigned

Knowledge, Skills, and Abilities.
• High School Diploma with 3-4 years systems/network administration required
• Knowledge of SQL a plus
• Ability to communicate technical guidance and instruction to users on the use of PC and/or mainframe applications and systems.
• Knowledge of computer security procedures and protocol
• Ability to interact effectively with all staff

Supervisory Responsibilities
• None

Supervision Received
• Works under general supervision of the IT Supervisor

Working Conditions
Overtime will be occasionally required. Travel will occasionally be required

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, handle or feel, reach with hands and arms, and talk or hear. The employee is frequently required to stand and walk. The employee must regularly lift and/or move up to 30 pounds and frequently lift and/or move up to 75 pounds.

Contact Name: Human Resources  |  Contact Email: humanresources@vhpla.com

Job Description:

Vantage Health Plan, Inc. is a distinguished local Health Insurance Company that offers competitive salaries and great benefits. Benefits include: Health, Dental, Life, Long Term Disability, Paid Time Off, 401(k), as well as corporate rates at area health clubs.

We are currently looking for a Member Service Representative for our Shreveport location.

Vantage Health Plan, Inc.

855 Pierrmont Road, Suite 109

Shreveport, LA  71106

 The Member Service Representative is primarily responsible for providing effective member service for all Vantage Health Plan, Inc. members by utilizing excellent, in-depth knowledge of company products. The Member Services Representative will answer member questions in a timely and professional manner explaining benefits and handling grievances.

Job Duties include but not limited to:

• Answer Member Services’ direct line by the 2nd ring, unless on another call.
• Respond to voice mail at least twice daily.
• Respond to Member and Providers’ e-mail requests on the day the e-mail was received.
• Research any prescription drug issue within the day of the request.
• Research any co pay needed within the day of the request.
• Research any bills that a Member has received and respond back within 48 hours of notification.
• Complete Workflow assignments in On-Base daily.

A high school diploma or GED is required. Louisiana Health Insurance License is preferred. Attention to detail, written and verbal communication skills, exceptional customer service skills, and excellent phone etiquette are required.

Vantage Health Plan encourages the professional growth of our employees so training opportunities are provided. We are an Equal Opportunity Employer.

Contact Name: Human Resources Department  |  Contact Email: humanresources@vhpla.com   Contact Phone: (318) 361-0900

Job Description:

Vantage Health Plan, Inc. is a growing company that offers competitive salaries and great benefits. Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, 401(k), as well as corporate rates at area health clubs. Vantage Health Plan is looking to hire a Medical Management Nurse to work in the Medical Management Department.

The Medical Management Nurse is responsible for reviewing each inpatient stay and outpatient procedures as applicable for medical necessity and meeting the appropriate level criteria.

Essential Duties & Responsibilities:
• Perform pre-admission, concurrent, and retrospective reviews as appropriate for all inpatient stays. 
• Forward every case that does not meet criteria to the Medical Director.
• Perform medical underwriting for groups and individuals prior to them being reviewed by the Medical Director.
• Calculate Annualized Bed Days per Thousand and other reports as requested.
• Review all Emergency Room Facility claims for emergency criteria.

Marginal Duties
• Assist in developing policies and procedures base on the UR/QM Committee determinations and maintain Policies & Procedures manual.
• Attend monthly UR/QM Committee meetings.
• Other duties as assigned.

Knowledge, Skills, and Abilities.
• Graduate of an accredited school of Nursing with current license to practice as an RN in the State of Louisiana.
• Exceptional interpersonal, verbal, and written communication skills
• Previous experience in Utilization Review, case management, and/or medical underwriting. 
• Customer service oriented attitude/behavior.
• Ability to work with limited supervision and to make decisions based on established policies and procedures.

Supervisory Responsibilities
• None
 
Supervision Received
• Works under general supervision of the Director of Medical Management.

Working Conditions
Overtime will be occasionally required. 

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, handle or feel, reach with hands and arms, and talk or hear. The employee is frequently required to stand and walk. The employee must regularly lift and/or move up to 10 pounds and frequently lift and/or move up to 25 pounds.

 

Contact Name: Human Resources  |  Contact Email: humanresources@vhpla.com

Job Description:

 The Medical Management Appeals Specialist in the Production Division is responsible for researching and preparing assigned VHP appeals for review for Commercial and Medicare lines of business.  The Appeals Specialist is responsible for reviewing all appeals received by VHP for accuracy, completeness, necessity, and type and then distributing them to the proper department for further attention and review.  The Appeals Specialist will be responsible for completing and submitting to Medical Directors the appeals as outlined below. 

Essential Duties & Responsibilities:
• Research and review all appeals prior to distribution through the proper Appeal channels in accordance with defined criteria.  Prepare notification and return documentation for incomplete or improperly submitted requests to the provider.  Process non-appeals if necessary as defined by the submission type (ie. Clean claim submission, etc.). 
• Prepare all appeals as assigned for review by the Medical Directors.  Classifications for appeals may include the following:  Payment disputes, filing limit disputes, denials for no authorization, benefit disputes, Part D reimbursements, claim billing disputes.  These would apply for both Par and Non Par providers for both Commercial and Medicare benefits.
• Review cases thoroughly to convey concise and accurate information to the Medical Directors for their determination and to ensure timely decisions.  Information provided may be based on all or part of the following critical knowledge bases:  General Coding and Billing Policy, Rev Codes, Rural Health Policy, Member Eligibility, Government and Company Compliance, VHP/Provider Contracts and Terms, Medicare Part D Regulations, VHP Company Policy including modifiers, CPT codes/POS, anesthesia billing, authorizations and referral requirements.    
• Prepare and review cases requiring advanced and/or specified knowledge of VHP policy and/or government regulations.  Be available to serve as a subject matter expert on cases that pertain to areas of individualized expertise.  Advise peers and senior staff on these areas to determine proper course of action.
• Properly document, track and process all appeals through the internal VHP systems including the Appeals Module, OnBase, and Claims Tracking.
• Prepare root cause reporting on provider appeals for VHP Management based on historical trends and demographics for refined review and concentrated training by the Provider Relations Department, Claims Department, and/or Compliance Department.
• Respond to any requests for additional information or consultation on appeals submitted to other departments and/or the Medical Directors.
• Correspond and communicate with providers and members or members’ representatives as needed during appeal processing.
• Prepare appeal determination notification letters as applicable.
• Assist Member Services, Claims, Provider Relations, Pharmacy, and Compliance Departments with collection of information, reporting, and specific review as requested.

Marginal Duties
• Other duties as assigned.
Knowledge, Skills, and Abilities:
• Bachelor’s Degree or two to five years experience in appeals processing or related field.
• Master level knowledge on individualized areas of appeal processing, including but not limited to Claims Processing, Coding and Billing, Medicare and governmental regulations, and VHP policy and procedures.
• Exceptional interpersonal, verbal, and written communication skills.
• Customer service oriented attitude/behavior.
• Ability to work with limited supervision and to make decisions based on established policies and procedures.
• Problem analysis and problem resolution at both a strategic and functional level.
• Ability to organize and manage multiple priorities.
• Ability to think ahead and plan over a multi-year time span.
• Ability to interact effectively with all staff at all levels of management.
• Ability to work under stress.

Supervisory Responsibilities
• None.

Supervision Received
• Works under general management of Director of Medical Management at Vantage Health Plan.
Working Conditions
Overtime may be occasionally required. 

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, handle or feel, reach with hands and arms, and talk or hear. The employee is frequently required to stand and walk. The employee must regularly lift and/or move up to 10 pounds and frequently lift and/or move up to 25 pounds.

Contact Name: human resources  |  Contact Email: humanresources@vhpla.com

Job Description:

Affinity Health Group, LLC is looking for a Family Practice Physician to join its rapidly growing, multi-specialty group practice within the Monreo/West Monroe, LA  area. 

The Family Practice Pysician will be joining our team at the Affinity Walk-In Clinic at 2408 Broadmoor Blvd, Suite 2  Monroe, LA  71201

 Affinity Health Group, LLC offers competitive salaries and great benefits.  Benefits include: Health, Dental, Life, Long Term Disability, Paid Time off, 401(k), as well as corporate rates at area health clubs.

The Family Practice Physician will provide direct care to patients.

Salary:: $185,000.00

Essential Duties & Responsibilities:
• Provides medical patient care by interviewing, examining and treating of clinical patients in order to meet their medical needs
• Educates patients on wellness, prevention and early detection by providing materials and resources to the patients and families
• Determines which referrals are required based on examination and patient needs
• Determines level of urgency of follow-up, referral/consultation appointments
• Exercises final medical judgment in all issues of health care
• Prescribes medical treatment and clinical drugs to patients
• Orders studies, test and ancillary services
• Documents all services in patient medical record
• Reviews on a regular basis long term cases that require ongoing medical attention
• Consults with Medical Director and other professionals on staff as needed regarding patient care, assessment, and education issues
• Participates in quality improvement, management, continuing education, and other patient care programs established by the hospital or clinic requirements
• Oversees mid-level medical staff as assigned as well as nursing clinical staff
• Maintains confidentiality of all patient information according to federal guidelines and regulations

Requirements:

•         Medical degree in medicine from an accredited school and licensed to practice in Louisiana
•         Current DEA and DPS Certificate of Registration
•         Minimum two years of direct work or intern experience

Contact Name: Human Resources  |  Contact Email: humanresources@vhpla.com   Contact Phone: 318-361-0900

Job Description:

The Medical Office at Regency
109 Regency Place
West Monroe, LA 71291 

Affinity Health Group, LLC is looking for a Family Practice Physician to join its rapidly growing, multi-specialty group practice for our  Medical Office at Regency. 

 Affinity Health Group, LLC offers competitive salaries and great benefits.  Benefits include: Health, Dental, Life, Long Term Disability, Paid Time off, 401(k), as well as corporate rates at area health clubs.

Job Summary: The Family Practice Physician will provide direct care to patients.
Salary:  $185,000.00

Essential Duties & Responsibilities:
·         Provides medical patient care by interviewing, examining and treating of clinical patients in order to meet their medical needs
·         Educates patients on wellness, prevention and early detection by providing materials and resources to the patients and families
·         Determines which referrals are required based on examination and patient needs
·         Determines level of urgency of follow-up, referral/consultation appointments
·         Exercises final medical judgment in all issues of health care
·         Prescribes medical treatment and clinical drugs to patients
·         Orders studies, test and ancillary services
·         Documents all services in patient medical record
·         Reviews on a regular basis long term cases that require ongoing medical attention
·         Consults with Medical Director and other professionals on staff as needed regarding patient care, assessment, and education issues
·         Participates in quality improvement, management, continuing education, and other patient care programs established by the hospital or clinic requirements
·         Oversees mid-level medical staff as assigned as well as nursing clinical staff
·         Maintains confidentiality of all patient information according to federal guidelines and regulations

Marginal Duties:
·         Assists in the resolution of complaints, requests and inquiries from patients
·         Performs other duties and responsibilities as assigned.

Knowledge, Skills, and Abilities.
·         Medical degree in medicine from an accredited school and licensed to practice in Louisiana
·         Current DEA and DPS Certificate of Registration
·         Minimum two years of direct work or intern experience
·         Knowledge of and ability to apply professional medical principles, procedures, and techniques
·         Thorough knowledge of pharmacological agents used in patient treatment
·         Effective verbal and written communication skills along with proper telephone etiquette
·         Performs in a tactful and professional manner

Supervisory Responsibilities
·         None
Supervision Received
·         Works under occasional supervision of the Medical Director

Working Conditions
Overtime will be occasionally required.

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, handle or feel, reach with hands and arms, and talk or hear. The employee is frequently required to stand and walk. The employee must regularly lift and/or move up to 25 pounds and occasionally lift and/or move up to 75 pounds

Contact Email: humanresources@vhpla.com   Contact Phone: 318-361-0900