Description:Data entry and computer work 90% of the timeWhat you'll do:• Responsible for maintaining, receiving, verifying medical documentation• Determines if medical decisions are required• Coordinates authorization for review in Medical Management System• Regular correspondence with members, providers, & other internal departments (CSC, Nurses, Physician Reviewers, Provider Relations, Marketing and TByrd Admins, etc.)• Ability to navigate through various systems to complete day-to-day tasks• Reviews medical information & ensures all necessary information is received• Reporting & research, unit and user testing, as needed.• Responsible for abiding by all applicable state and federal regulations as well as the BCBSA and BCBSNE mandates related to claims, preauthorizations, including URAC guidelines and timeliness.• Work with internal staff to ensure that URAC accreditation is maintained• Responsible for meeting internal quality and production standards, as well as Service Level Agreements (SLA's) for the teamTo be considered for this position you must have:• Associates Degree & 1 year of experience in a health care related field• Ability to multi-taskThe strongest candidates for this will also possess: • Bachelor's Degree• Medical Office experience 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 or email (%) 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.