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Aston Carter Remote Medical Reimbursement Specialist in Des Moines, Iowa

Description:

Aston Carter is currently hiring Reimbursement Specialists for remote opportunities! This team ensures accurate adjudication of claims by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

This position will be 100% remote - can sit anywhere but Hawaii and Alaska. This need is due to an influx of work and cleanup efforts needed to be resolved in a short timeframe.

Daily Duties:

  • Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

  • Employees will process 60+ claims daily

  • Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules then conduct clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.

  • Translates medical policies into reimbursement rules.

  • Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for edits.

  • Coordinates research and responds to system inquiries and appeals.

  • Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.

  • Performs pre-adjudication claims reviews to ensure proper coding was used.

  • Prepares correspondence to providers regarding coding and fee schedule updates.

  • Trains customer service staff on system issues.

  • Works with provider contracting staff when new/modified reimbursement contracts are needed.

  • Follow provider dispute policy for review of medical records to determine if documentation matches medical coding completed as part of billing submission.

Required Skills & Qualifications:

  • 2-3 years related experience; or any combination of education and experience that is relevant

  • Current American Academy of Professional Coders (AAPC) CPC or American Health Information Management Association (AHIMA):

  • RHIA, RHIT, CCS, CCS-P coding certification.

    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 astoncarteraccommodation@astoncarter.com (%20astoncarteraccommodation@astoncarter.com) 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.

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