Examiner I (Remote, $15/hour)

American Specialty Health Incorporated

3d•Remote

About The Position

American Specialty Health Incorporated (ASH) is seeking an Examiner to join our Medical Necessity/Benefits Administration department. The primary function of this position is to enter data from Medical Necessity Review Form (MNR Form) and Clinical Quality Evaluator (CQE) worksheets. Training will cover ASH Company Culture and Values; MNA Department SOPs; IHIS, ASHCore, ELIG, Other ASH Company Software Applications; and Processing requirements for Medical Necessity Review Forms. 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 a stable internet connection with a minimum speed of 50 Mbps download and 10 Mbps upload, with 100 Mbps download and 20 Mbps upload recommended for higher quality video meetings, and the ability to participate by video in online meetings.

Requirements

High School Diploma or GED certificate required.
2 years of data entry experience (10,000 keystrokes per hour - minimum).
Working knowledge of the computer keyboard required.
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.
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.
Ability to see, speak, and hear other personnel and/or objects.
Ability to communicate both in verbal and written form.
Capable of using a telephone, computer keyboard, and mouse.
Ability to lift up to 10 lbs.

Nice To Haves

Stable connection to Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network.
Consistent 50 down/10 up Mbps minimum internet speed; 100 down/20 up is recommended.

Responsibilities

Enters data from MNR Form and/or CQE worksheets, maintaining a minimum production level of 20 MNR Forms per hour and quality at or above 98.0%.
Processes a minimum level of back-end treatment forms as required.
Reviews MNR forms for completeness, verifies member eligibility, and creates patient records.
Checks patient and provider information on MNR Forms against information in the Integrated Health Care System (IHIS).
Inputs all required data from MNR forms into IHIS in accordance with MNA guidelines, including Out of Network denials, Submission Timeframe Denials, and Network Access Denials.
Forwards MNRs to the Clinical Quality Evaluators for medical necessity verification.
Retrieves patient files or history for the CQEs as necessary.
Reviews CQE’s worksheets for completeness.
Inputs all required data from worksheets into IHIS.
Processes CQE worksheets in accordance with MNA guidelines.
Forwards worksheets to Administrative Support staff for final processing.
Demonstrates proficiency in eligibility verification, provider verification, and identifying/pre-screening different form types.
Adds new members and sequence numbers in Member Maintenance.
Researches via ASHCore logs.
Performs production query via Reports Manager.
Forwards eligibility research to Membership.
Processes Duplicate requests.
Contacts provider’s office to clarify missing or illegible information on MNR forms.
Completes daily tally sheets and production reports for Supervisor.
Performs other duties as assigned.
Complies with all policies and standards.