Administrative Analyst (Remote)

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.

• 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

• 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.

Qualifications

• High School Diploma or GED certificate required.
• 2 years progressive experience performing administrative duties. Internal experience at ASH required.
• Proficient in MS Word, Excel and Access.
• Knowledge of Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC) regulations and related notifications helpful.
• Demonstrated strong analytical and written communication skills.

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 us