Claim Benefit SpecialistPrimary Location: New Albany, Ohio
Additional Locations: OH-New Albany Apply
Reviews and adjudicates Medicare medical claims in accordance with CMS claim processing guidelines. Role requires strong keyboard skills, attention to detail and the ability to work independently in a production environment.
Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues. Routes and triages complex claims to Senior Claim Benefits Specialist.
Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
May facilitate training when considered topic subject matter expert.
In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor).
Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools). Background Experience: Experience in a quality and production environment.
Claim processing experience.
Strong Computer Navigation Skills
High School or GED equivalent.
Additional Job Information: Understanding of medical terminology.
Oral and written communication skills.
Ability to maintain accuracy and production standards.
Attention to detail and accuracy.
Required Skills: General Business - Maximizing Work Practices, Service - Demonstrating Service Discipline, Service - Providing Solutions to Constituent Needs Desired Skills: General Business - Communicating for Impact, Service - Creating a Differentiated Service Experience, Technology - Leveraging Technology Potential Telework Position: No Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
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