Eligibility Research Rep I (Seasonal - Remote, $15/hr)

American Specialty Health Incorporated

96d

About The Position

American Specialty Health Incorporated (ASH) is seeking a Research Representative to join our Eligibility department. The primary function of this position is to research and resolve eligibility verification requests in an appropriate and timely manner. 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 (minimum 50 Mbps download and 50 Mbps upload speed).

Requirements

• High School Diploma or GED certificate required.
• 1 year experience with 10 key, typing, and computer skills. 8,000 key strokes per hour required.
• Experience with claims processing or eligibility verification preferred.
• Excellent customer service skills, with experience making outbound calls and meeting expectations for productivity and accuracy.

Responsibilities

• Researches and resolves member eligibility requests.
• Must maintain a minimum production level of 85 claims, 60 CSS/MNA, or 60 ASHLink requests per day pro-rata with no less than 98% accuracy.
• Ability to assist in multiple functions as needed.
• Ability to participate in peer mentorship as needed.
• Follows confidentiality guidelines to ensure security measures are enforced and proprietary information is protected.
• Verifies member eligibility from eligibility file, communications log, and health plan websites or by calling the health plan directly when all other resources are exhausted.
• Inputs and saves verified member’s information into the communications log and/or member maintenance.
• Ensures the highest quality of customer service by maintaining a professional and courteous manner.
• Processes research immediately to ensure same day turnaround time is met.
• Completes research and returns ASHCore log to MNA bucket.
• Processes research same day to ensure 24 hour turnaround time is met.
• Makes follow up calls same day to providers and members to give results of research.
• Transfers providers to provider queue if question is not related to eligibility.
• Transfers members to member queue if caller has detailed questions or wishes to file a complaint.
• Updates member and group records as needed.
• Resolves ASHCore log when process is completed.
• Processes research within 24 hours to ensure 48 hour turnaround time is met.
• Builds or updates member and group records in IHIS including documentation in notes.
• Creates ASHCore log and resolves whenever a health plan call is made.
• Completes pend screen when research is completed.
• Processes research within 24 hours to ensure 48 hour turnaround time is met.
• Creates ASHCore logs and resolves whenever a health plan call is made.
• Completes ASHLink logs by responding to providers when research is complete.
• Attends staff and other meetings to discuss issues and foster teamwork among department personnel.
• Performs other duties as assigned.
• Complies with all policies and standards.

Benefits

• Equal Opportunity/Affirmative Action Employer.
• Right to request an accommodation for individuals with disabilities.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees