Provider Claims Representative – Aston Carter Remote Jobs

Job Type: Provider Claims Representative from home
Location: Houston work from home
Company: Aston Carter

Responsibilities:

• In a busy contact center, delivers exceptional customer service pertaining to Veteran care provided by the Community Care Network (CCN).
• Answers incoming calls and chat messages on requests for authorizations for mental and physical healthcare, provider availability and status, and claim payment and status.
• Focuses on first call resolution and/or the proper call escalation methods while accurately assessing caller requests, responding to inquiries From callers, and processing requests.
• May make calls to schedule appointments based on requests from veterans or the VA.
• Thorough account research and review, administrative eligibility problems are resolved.

Inbound & Outbound are in charge of responding to inquiries regarding:

• Status of authorization

• Services covered

• Provider details

Contracting with providers

• Status of claims

• Reconsiderations of claims

• Appealing claims

• Reauthorizations – service requests

• Inquiries regarding scheduling, appointment status, reappointments, and reschedules

• Giving preference to veterans (Nuance)

• Examinations

Emergency care

• Authorizations for pharmacies

• The resurrected

• Vaccine, IVF, Donor, and Transplant questions