Hospital Account Rep
Amerigroup (Miami, Florida)

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JOB SUMMARY:     Provide account management services to select hospitals within the AMERIGROUP network, including issue resolution, claims investigations and provider education.

PRIMARY RESPONSIBILITIES:     
1.     Track and manage claims issues through regular interaction with key hospital personnel.
2.     Identify, investigate and resolve root cause problems to reduce the number of billing complaints/appeals.
3.     Provide education and orientations with hospital staff on a regular basis (or as needed) regarding AMERIGROUP policies and procedures, authorizations, Quick Reference Guides, etc.
4.     Collaborate with the Director of Hospital Networks to identify possible billing inefficiencies or issues.
5.     Verify contract implementation with Corporate Configuration.
6.     Ensure hospital staff is accessing AMERIGROUP's IVR and Internet-based functions while promoting electronic billing.
7.      Other duties as assigned.

EDUCATION AND EXPERIENCE
Education
Required:
*     Minimum High School Diploma

Preferred:
*     Bachelors degree in related field

Experience
Required:
*     Minimum 2 years experience in provider services environment and claims investigations

Preferred:
*     Experience in hospital claims and operations in a managed care setting preferred

Certification and Licensure:
*     N/A

KNOWLEDGE AND SKILLS
Required:
*     Knowledge of claims policies and procedures
*     Familiarity with ICD-9, DRG, Revenue Code and CPT coding
*     Knowledge of MS Office

Preferred:
*     Knowledge of hospital reimbursement methodologies
*     Contract language and interpretation a plus
*     Knowledge of managed health care a plus

Other:
*     Demonstrates organizational skills.
*     Excellent written and verbal communication skills.
*     Ability to interact with all relevant components of the health care system.
*     Ability to work independently and as part of a team.
*     Ability to demonstrate professionalism in all situations.
*     Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION

Item     Measure
*     # Direct Reports     0
*     # Indirect Reports     0
*     Budgetary $ Responsibility     0


Physical Requirements
*     Must be able to travel on common carriers, drive an automobile and adhere to AGP's travel policy.

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