Posting ID: JP-002661705
***Looking for An Experience Medical Claims Processor in The Austin/Killeen Area. Position is Remote but Will Have to Live Local***
The Claims Processor is responsible for claims processing, research and adjudication to correctly apply benefit determinations on routine uncomplicated medical claims (CMS 1500 and UB04) and Rx claims in accordance with claim processing guidelines,
WHAT IS EXPECTED (ESSENTIAL FUNCTIONS)
Processes and adjusts uncomplicated professional and facility and Rxclaims according to claims processing guidelines
Pends claims as directed by departmental policies and procedures, follows up for resolution and process pended claims immediately following a benefit / payment determination
Works claims inventory from assigned queues to ensure all claims process within established turnaround time as directed by department policy and procedures
Reviews all output reports to ensure accurate benefit and rider determinations
Completes reports to ensure prompt payment of claims
Coordinates win-scanning of claims related documents into members MACESS folder
Identifies and review problems systematic or procedural with Supervisor for timely follow-up and correction
Consistently meet /exceed productivity standards and accuracy standards for payment, procedural and financial
Performs follow-up and takes all necessary actions required to resolve all errors and findings assessed by the Quality Review Team
Performs task individually and as part of an assigned team
medical terminology, claims management, collections medical, claims processing, Claim, Health insurance, Claims analysis, Medical billing, accounts payable/receivable, healthcare claim, benefits verification
Additional Skills & Qualifications:
*Must be able to work within an Excel spreadsheet. *Comfortable performing highly repeatable tasks.
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. 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 firstname.lastname@example.org 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.
Recruiter: KeiErica Vanduren