Administrative Support Representative (Remote, $15.00/hr)

American Specialty Health Incorporated

2d•Remote

About The Position

American Specialty Health Incorporated (ASH) is seeking an Administrative Support Representative for its Medical Necessity/Benefits Administration department. The position acts as a liaison between the Medical Necessity/Benefit Administration Department and the Clinical Quality Evaluation Department. This is a remote work-from-home position. Training is provided remotely, and the employee must work from a designated home workspace using company-provided technology. A stable internet connection is required, with a minimum consistent speed of 50 Mbps download and 10 Mbps upload; 100 Mbps download and 20 Mbps upload is recommended for higher-quality video meetings. The role supports medical necessity review workflows by researching turnaround times, coordinating and preparing Medical Necessity Review Forms, making and documenting provider and member calls, routing forms and reports, managing fax and mail processes, and running queries and reports. The position requires accuracy, organization, customer service, confidentiality, and the ability to manage work in a changing environment with interruptions.

Requirements

High school diploma or GED certificate.
Two years of data-entry experience.
Working knowledge of computers, including word processing and spreadsheets.
Experience with Microsoft Word and Excel.
Ability to interact positively and respectfully and maintain cooperative working relationships.
Ability to provide excellent customer service to internal and external customers.
Excellent listening and interpersonal communication skills.
Ability to organize, prioritize, multitask, and manage time effectively.
Accuracy and productivity in a changing environment with constant interruptions.
Ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
Ability to maintain strict confidentiality.
Ability to work from home in a designated work area with company-provided technology.
A consistent internet connection with at least 50 Mbps download and 10 Mbps upload speed.

Nice To Haves

Internal data-entry experience at ASH.
Experience with Microsoft Access.

Responsibilities

Research turnaround times using the Medical Necessity In Process Report.
Check with Medical Necessity/Benefits Administration staff to determine whether Medical Necessity Review Forms are in house and, when they are, advise staff to process them as a priority.
Reprint Medical Necessity Review Forms that cannot be located.
Call practitioners to request that Medical Necessity Review Forms be re-faxed when necessary.
Document phone calls in ASH's proprietary system according to department guidelines.
Forward faxed Medical Necessity Review Forms to the appropriate Clinical Quality Evaluation team for review.
Call providers and members as required by the state and ensure verbal notifications comply with state regulations.
Document calls in the state-required log screen.
Process a minimum of 100 state-required calls per day.
Prepare Medical Necessity Review Forms and ensure all forms are accounted for on the Clinical Quality Evaluation Daily Report.
Bundle forms and reports by team and deliver them to Clinical Quality Evaluation within established standards.
Print and deliver file history as needed.
Fax Medical Necessity Review Response Forms to practitioners using Broadfax.
Remove data-entry errors from batch jobs and FoxPro.
Prepare fax files for Broadfax and remove failed faxes from Broadfax, assisting with mailing them manually to practitioners.
Contact practitioners regarding medical necessity determinations as required by state law.
Run queries and reports, including Medical Necessity Review Form queries in FoxPro.
Fax and mail Medical Necessity Review Forms as needed.
Perform other duties as assigned.
Comply with all policies and standards.