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Location: Either Office Based or 75 miles Remote

• Must have MEDICARE CLAIMS PROCESSING EXP ***
  JOB SUMMARY:
  Under general supervision evaluates intermediate level, simple to moderately complex, claims to determine the type and amounts of benefits payable. Performs all authorized duties in the processing of claims allocated to the assigned market consistent with all applicable company and departmental policies.

PRIMARY RESPONSIBILITIES:
1.Processes all intermediate level claims transactions.

2.Processes primary care encounter information and fee for service claims received in both paper and automated formats into AMERIGROUP’s claims systems

3.Accurately interprets, understands and applies Medicare product contracts.

4.Meets or exceeds established quality and production standards.

5.Reviews and responds to quality audit assessments and action grams in a timely manner.

6.Works with other departments to resolve issues.

7.Prepares correspondence, responds to phone logs & contact logs, generates action grams, and completes projects for all markets.

9.Adheres to company and departmental policies and procedures, as well as HIPAA regulations.

10.Understands and implements appropriate claims processes and courses of action when adjudicating claims.

11.Other duties as assigned.

EDUCATION AND EXPERIENCE:

Education
Required:
• High school diploma or GED.
Preferred:
•College degree or some additional college level courses.

Years and Type of Experience
Required:
•Minimum of three years in a production unit or office environment including a minimum of 2 years Medicare medical claims processing, or demonstrated proficiency as an AMERIGROUP Claims Analyst I.
Specific Technical Skills
Required:
•Intermediate Microsoft Office skills.
•Intermediate understanding of medical terminology, claims coding, and standard claims forms used for physician and hospital billings.
•Analytical/Problem Solving Skills.
•Knowledge of state guidelines and regulations applicable to Medicaid.

Certifications or Licensures
Required:
•N/A

Other:
Required:
•Strong interpersonal skills
•Demonstrates initiative; is proactive in problem resolution; ability to multitask
•Able to work independently and use reference material to resolve claims related questions.

SCOPE INFORMATION

1. Direct Reports: 0
2. Indirect Reports: 0
   Budgetary $ Responsibility: 0

PHYSICAL REQUIREMENTS:
The physical requirements 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.

•Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
•Ability to communicate both in person and/or by telephone.
•Data entry using repetitive motion

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://amerigroup.contacthr.com/16599603