Administrative Analyst (Remote)

American Specialty Health Incorporated

6d•$16 - $17•Remote

About The Position

American Specialty Health Incorporated (ASH) is seeking an Administrative Analyst to join our Medical Necessity/Benefits Administration department. The primary purpose of this position is to generate, mail and track member service denial notifications in accordance with URAC, NCQA, CMS, DMHC and ASH standards.

Requirements

High School Diploma or GED certificate required.
2 years progressive experience performing administration duties.
Internal experience at ASH required.
Proficient in MS Word, Excel and Access.
Demonstrated strong analytical and written communication skills.

Nice To Haves

Knowledge of Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC) regulations and related notifications helpful.

Responsibilities

Generates and mails member service denial notifications to members, health plans and practitioners.
Develops and maintains procedures related to member service denial processes.
Revises service denial letters as mandated by URAC, NCQA, CMS, DMHC and contracted health plans.
Revises service denial matrix as mandated by URAC, NCQA, CMS, DMHC and contracted health plans.
Coordinates workflow with MNA and CQE to ensure member service denial notifications are appropriately sent to members, health plans and practitioners.
Enters necessary information in the system to track service denials notifications.
Creates and submits member service denial logs to contracted health plans on a daily/monthly basis.
Reports and tracks service denial notifications turn-around time on a daily/monthly basis.
Ensures service denial notifications turn-around time standards are consistently met.
Maintains confidentiality of all member, provider, client and proprietary information
Provides administrative support
Assists manager with special projects and reports as needed.
Assists supervisor (s) with administrative duties as needed.
Assist with the preparation of files for various audits.
Runs system queries and reports as needed.
Performs other duties as assigned.
Complies with all policies and standards.