Rebecca Gant Email & Phone Number

Frederick, Md, Us

Maryland, United States

District Of Columbia, United States

Washington D.C. Metro Area

Washington, Dc

Washington, Dc

Responsible for recruiting Medical and Behavioral Health professionals in the Northeast Region for AMERIGROUP network.Responsible for analyzing, identifying, and monitoring provider's adequacy, issues, and concerns for all members medical needs.Conducts on-site provider education forums, orientations, and in-service training to ensure providers are familiar with AMERIGROUP'S benefits, policies and procedures, AND regulations for Department of Health and Mental Hygiene (DHMH).Responsible for interventions and follow-ups pertaining to provider complaints, training and mentoring of other Provider Relations Representatives along with resolving internal and external network issues.Assists with negoitation of Single Case Agreements.Determines the accuracy of ancillary contractual rates.

Responsible for maintaining current medical offices and recruiting potential candidates for pre-employment and employee's annual examination network.Responded to client and examinee inquiries while researching and resolving issues related to network coverage's. Responsible for daily administration and operation of provider relations, processing provider information changes and education and training of facility staff to meet clients requirements and needs.Monitor and evaluate organizational and client satisfaction levels while identifying areas of improvement.

Responsible for recruiting, negotiating, and contracting various healthcare professionals and ancillary support for company network.Maintained accurate and concise notes on recruitment efforts via database while advising management on unusual events, trends, and issues.Recruited over 150 medical professionals, processed in timely manner fee schedules, employer groups and applications to ensure operational readiness.

Responsible for researching and resolving claim issues concerning incorrect benefits and payments.Accountable for responding and the correspondence from Healthcare Physician's offices, Hospitals, and Clients regarding benefits and payments, resolving processing inconsistencies and discrepancies utilizing companies policies and procedures.Responsible for replying to complex service request from field representatives in a timely manner along with utilizing client specific claims criteria tool.

Maintained quality figures and data for claims department and support areas; developed audit guidelines and procedures for our Members Services and Network Service Department.Identified unusual behaviors, patterns of errors and/or training issues while preparing reports containing individual and department accuracies and inaccurate figures.

Bachelor Of Science, Psychology/ Business Administration

Bachelor Of Business Administration (Bba), Psychology