Remote Medical Claims Specialist

• Summary:*
• Responsible for the execution of the non-clinical aspects of the Utilization Management process.
• Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations, request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a case.
• Work seamlessly with other interdisciplinary teams to ensure members’ needs are met.
• Provide confidential administrative support and assistance to the department in all aspects of daily program operations.
• Required Experience:*
• At least 1-2 years of previous experience in Medical Claims, Medical Billing or Medical AR required.
• Must have Billing experience with IDT/CPT/Diagnosis codes
• Preferred experience – Managed Care, benefits review/eligibility, UM PriorAuthorizations, claims/claim investigation.
• Previous system user experience in a highly electronic environment required.
• Knowledge of medical terminology and medical payment preferred.
• Key Accountabilities:*
• Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities.
• Perform accurate and timely intake and data entry for all UM authorization requests and referrals for all lines of business, upon receipt of inbound utilization management requests, via call, fax, and web portal, in accordance with departmental policy and regulatory requirements.
• Triage cases and assign receipts to appropriate teams.
• Respond to inquiries from providers, facilities, and members.
• Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
• Enter and maintain documentation in the medical management workflow tool, meeting defined timeframes and performance standards.
• Provide phone management for both incoming and outgoing calls.
• Communicate with members and providers as required.
• Perform other related projects and duties as assigned.
• Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
• Support communication and coordination with delegated entities, as necessary. * *
• Details:*
• Pay: $17 – $18/hr. based on relevant experience.
• Pay cycle – Weekly | Medical, Dental and Vision Benefits offered.
• Schedule: Monday to Friday | 8:30am – 5:00pm EST
• 100% remote | Equipment Provided
• Position will start as a 3-6+ month contract position. Contract may be extended or remain permanent.

About Aston Carter:

At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless. Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit [AstonCarter.com.](AstonCarter.com) Aston Carter is a company within Allegis Group, a global leader in talent solutions. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email [[email protected]](mailto:%[email protected]) for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.