American Specialty Health Incorporated (ASH) is seeking an Administrative Support Representative to join our Medical Necessity/Benefits Administration department.

The primary function of this position is to act as a liaison between the Medical Necessity/Benefit Administration (MNA) Department and the Clinical Quality Evaluation Department.

Remote Worker Guidelines

• Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Responsibilities

• Researches turn-around time utilizing the Medical Necessity In Process Report.
  • Checks with MNA staff to see if the Medical Necessity Review Form (MNR Form) is in house. If so, advises staff to process the MNR Form as priority.
  • Reprint MNR Forms that cannot be located.
  • Calls practitioner to request re-faxing of MNR Forms as necessary.
  • Documents all phone calls in ASH proprietary system per MNA guidelines.
  • Forwards faxed MNR Forms to the appropriate Clinical Quality Evaluation for review.
• Call Providers and Members as required by the State.
  • Ensure providers are notified verbally in accordance with state regulations.
  • Ensure members are notified verbally in accordance with state regulations.
  • Document all calls in the state required log screen.
  • Processes a minimum of 100 state required calls per day.
• Prepares Medical Necessity Review Forms (MNR Forms).
  • Ensures all MNR Forms are accounted for on the CQE Daily Report.
  • Bundles MNR Forms and reports by teams.
  • Delivers MNR Forms and reports to CQE within standards.
  • Print and deliver file history as needed.
• Systematically faxes MNR Response Forms (MNRF) to practitioner using Broadfax.
  • Removes data entry errors from the batch jobs and FoxPro.
  • Prepares fax files for Broadfax.
  • Removes the MNRFs that failed to be faxed from Broadfax and assists with manually mailing them to the practitioner.
  • Contacting practitioner on medical necessity determinations, as required by State Law.
• Runs a variety of Queries and Reports.
  • Runs MNRF queries in FoxPro.
  • Fax and Mail MNRFs as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• High School Diploma or GED Certificate required.
• 2 years of data entry experience and working knowledge of computers including word processing and spreadsheets required.
• Internal data entry experience at ASH preferred.
• Microsoft Word and Excel experience required. Experience with Microsoft Access highly desirable.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements

• Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.

#LI-Remote #MNA #Healthcare #MNA #Claims #Admin