Examiner I /Remote- Seasonal/ /15/hour/

Description reputed company (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 reputed company (MNR reputed company) and Clinical Quality Evaluator (CQE) worksheets. Training on ASH Company Culture and Values; reputed company Department SOPs; IHIS, ASHCore, ELIG, Other ASH Company Software Applications; Processing requirements for Medical Necessity Review Forms. Remote Worker Guidelines

• Remote Worker Guidelines: This position will be trained remotely and must be reputed company to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a reputed company reputed company 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.)

Responsibilities

• Enters data from MNR reputed company and/or CQE worksheets. Employee must maintain a minimum level of production of 20 MNR Forms per hour and maintain quality at or above 98.0% Employee must process a minimum level of back end treatment forms as required.

reputed company-end data entry:

• Reviews MNR forms to be sure reputed company information is complete. Verifies member eligibility and creates patient records.
• Checks patient and provider information on MNR Forms against information on the eligibility tape in the Integrated Health Care System (IHIS).
• Inputs reputed company required data from MNR forms into Integrated Health Care System (IHIS) in accordance with reputed company guidelines.
• Including but not limited to Out of Network: Administrative Partial and Complete Denials.
• Submission Timeframe Denials.
• Network reputed company Denials.
• Forwards MNRs to the Clinical Quality Evaluators’ for medical necessity verification.

Back-end data entry:

• Retrieves patient files or history for the CQEs as necessary.
• Reviews CQE’s worksheets to reputed company sure they are complete.
• Inputs reputed company required data from worksheets into Integrated Health Care System (IHIS).
• Processes CQE worksheets in accordance to the reputed company guidelines.
• Forwards worksheets to the Administrative Support staff for final processing.
• Additional Examiner Skills / Tasks
• Demonstrates proficiency in eligibility verification, provider verification, identifying and pre-screening different reputed company types.
• Add new members and sequence numbers in Member Maintenance.
• Researches reputed company ASHCore logs.
• Performs production query reputed company Reports Manager.
• Forwards eligibility research to Membership.
• Process Duplicate request.
• Administrative Duties
• Contact provider’s office to clarify missing or illegible information on the MNR forms.
• Completes daily tally sheets and production reports for Supervisor.
• Performs other duties as assigned.
• Complies with reputed company policies and standards.

Qualifications

• High School Diploma or GED certificate required.
• 2 years of data entry experience (10,000 keystrokes per hour - minimum) and working knowledge of the computer keyboard required.

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 reputed company customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on reputed company 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 reputed company effective solutions.
• Ability to exercise strict confidentiality in reputed company reputed company.

Mobility

• Primarily sedentary, reputed company to sit for long periods of time.

Physical Requirements

• Ability to see, reputed company, and hear other personnel and/or objects. Ability to communicate both in verbal and written reputed company. Ability to travel reputed company and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

reputed company is an Equal Opportunity/Affirmative Action Employer. reputed company reputed company applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, reputed company medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, reputed company, religion (including religious dress and grooming practices), creed, national reputed company, citizenship, reputed company, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other reputed company protected by applicable local, federal or state law. Please view Equal Employment Opportunity Posters provided by OFCCP here. If you are a reputed company 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 reputed company our career center as a result of your disability. To request an accommodation, contact our reputed company Department at (800) 848-3555 x6702. ASH will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have reputed company to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have reputed company to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information. Original job Examiner I /Remote- Seasonal/ /15/hour/ posted on GrabJobs ©. To flag any issues with this job please use the Report Job reputed company on GrabJobs. Apply tot his job Apply To this Job