Note: The job is a remote job and is open to candidates in USA. American Specialty Health is seeking an Administrative Support Representative to join their Medical Necessity/Benefits Administration department. The primary function of this position is to act as a liaison between the Medical Necessity/Benefit Administration Department and the Clinical Quality Evaluation Department.
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
Skills
- High School Diploma or GED Certificate required
- 2 years of data entry experience and working knowledge of computers including word processing and spreadsheets required
- Microsoft Word and Excel experience required
- Internal data entry experience at ASH preferred
- Experience with Microsoft Access highly desirable
Benefits
- 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.
- If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability.
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