Administrative Support Representative (Remote, $15.00/hr)

American Specialty Health Incorporated (ASH) is seeking an Administrative Support Representative to join our Medical Necessity/Benefits Administration department.

The primary function of this position is to act as a liaison between the Medical Necessity/Benefit Administration (MNA) Department and the Clinical Quality Evaluation Department.

Remote Worker Guidelines

• 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

• Researches turn-around time utilizing the Medical Necessity In Process Report.
  • Checks with MNA staff to see if the Medical Necessity Review Form (MNR Form) is in house. If so, advises staff to process the MNR Form as priority.
  • Reprint MNR Forms that cannot be located.
  • Calls practitioner to request re-faxing of MNR Forms as necessary.
  • Documents all phone calls in ASH proprietary system per MNA guidelines.
  • Forwards faxed MNR Forms to the appropriate Clinical Quality Evaluation for review.
• Call Providers and Members as required by the State.
  • Ensure providers are notified verbally in accordance with state regulations.
  • Ensure members are notified verbally in accordance with state regulations.
  • Document all calls in the state required log screen.
  • Processes a minimum of 100 state required calls per day.
• Prepares Medical Necessity Review Forms (MNR Forms).
  • Ensures all MNR Forms are accounted for on the CQE Daily Report.
  • Bundles MNR Forms and reports by teams.
  • Delivers MNR Forms and reports to CQE within standards.
  • Print and deliver file history as needed.
• Systematically faxes MNR Response Forms (MNRF) to practitioner using Broadfax.
  • Removes data entry errors from the batch jobs and FoxPro.
  • Prepares fax files for Broadfax.
  • Removes the MNRFs that failed to be faxed from Broadfax and assists with manually mailing them to the practitioner.
  • Contacting practitioner on medical necessity determinations, as required by State Law.
• Runs a variety of Queries and Reports.
  • Runs MNRF queries in FoxPro.
  • Fax and Mail MNRFs as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• High School Diploma or GED Certificate required.
• 2 years of data entry experience and working knowledge of computers including word processing and spreadsheets required.
• Internal data entry experience at ASH preferred.
• Microsoft Word and Excel experience required. Experience with Microsoft Access highly desirable.

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 co