by twochickswithasidehustle | Oct 9, 2024 | Uncategorized
Description
American Specialty Health Incorporated (ASH) is seeking a focused Claims Examiner to work in a production environment. This position is responsible for the accurate review, input, and adjudication of claims in accordance with regulations, ASH standards and contractual obligations of the organization. Claims is an integral department of ASH’s offerings to empower people to live longer and healthier lives. We are responsible for tracking the receipt of claims, adjudication, and payment of claims. Due to the nature of the business and always evolving rules and guidelines, Claims is a fun and fast-paced team that enjoys working side by side, developing new ideas for efficiency, and prioritizes a strong focus on exceeding regulatory and contractual standards. Our driving mission is to offer world-class customer service (and expedited reimbursement) to healthcare providers on behalf of our members. Claims offers a career path progression that begins upon hire and allows development-focused staff to achieve two promotions in just one year. We succeed as a team and we prioritize professional development, considering ourselves an operational springboard to spring talented and driven employees toward their future goals.
Remote Worker Considerations:
Candidates who are selected for 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 remote/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 (minimum internet download of 50 Mbps and 10 Mbps upload speed).
Responsibilities
- Processes claims accurately and efficiently.
- Reviews all incoming claims to verify necessary information.
- Determines that correct member and provider records are chosen and utilized to process claims.
- Enters claims data and information into the computerized Claims Processing System.
- Maintains all required documentation of claims processed and claims on hand.
- Adjudicates claims in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules.
- Maintains production standards; for direct data entry claims this includes processing an average of 31 claims per hour, with an accuracy rate of 98.5% over each pay period.
- Verifies data of scanned paper claims at stated standards.
- Provides backup for other examiners within the department.
- Promotes a spirit of cooperation and understanding among all personnel.
- Attends organizational meetings as required.
- Adheres to organizational policies and procedures.
- Maintains confidentiality of all claim files, claims reports, and claims related issues.
Qualifications
- High school diploma required.
- 6 months data entry experience with 10 key and word processing; minimum 10,000 keystrokes per hour required.
- Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.
- Proficient in MS Office.
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.
- Ability to work and maintain production in a work-from-home (WFH) environment
- Demonstrated ability to show self-discipline to meet production goals.
- Demonstrated accuracy and productivity in a changing environment.
- Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions, and to utilize constructive criticism to improve.
- Ability to exercise strict confidentiality in all matters.
Mobility
Primarily sedentary, able to sit for long periods of time.
Physical Requirements
Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions
Work-from-home (WFH) environment.
American Specialty Health is an Equal Opportunity/Affirmative Action Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
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. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.
ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access 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 access 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.
by twochickswithasidehustle | Oct 9, 2024 | Uncategorized
Description
American Specialty Health Incorporated is searching for an exceptional customer service representative to join our Provider Relations Team. The ideal candidate will professionally respond to practitioner inquires via the telephone queue system regarding credentialing, re-credentialing and contracting to ensure efficient and effective resolution of practitioner inquires or complaints and to deliver high quality customer service.
Remote Worker Considerations
Candidates who are selected for 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 remote/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 (minimum internet download of 50 Mbps and 10 Mbps upload speed).
Responsibilities
- Answers incoming calls in a professional, accurate, timely and courteous manner from the Provider Relations and Credentialing queue.
- Assists practitioners, staff, and clients with questions regarding credentialing, re-credentialing, participation requirements, contractual issues and high-level administrative problems.
- Performs credentialing and re-credentialing activities according to plan specifications.
- Forwards complex requests that require research to the appropriate ASHCore bucket or PRL supervisor to achieve appropriate resolution.
- Captures practitioner complaints and resolves or forwards to the appropriate ASHCore bucket or PRL supervisor for resolution.
- Captures practitioner change information, documents and forwards as required to record changes in appropriate databases.
- Handles necessary administrative duties to properly support, document and resolve practitioner inquires.
- Maintains confidentiality of practitioner files, participation data, practitioner records/documents and all discussions relative to recruiting, contracting, and credentialing processes.
- Attends department and all-staff meetings to increase knowledge and foster teamwork.
- Pull CAQH applications when provider calls in with CAQH number. Drop application in designated folder.
- Download CAQH applications for PTOT practitioners that are being added to a provider.
Qualifications
- Associate’s degree or equivalent preferred. High school diploma required.
- Minimum two years of progressive experience performing customer service duties preferred.
- Specialty health care or health care experience preferred.
- Credentialing and re-credentialing experience preferred.
- Proficient in MS Office with experience in word processing and spreadsheet applications.
- General understanding of Provider Relations Guidelines.
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 speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions
Work from home (WFH) environment.
American Specialty Health is an Equal Opportunity/Affirmative Action Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
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. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.
ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access 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 access 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.
by twochickswithasidehustle | Oct 9, 2024 | Uncategorized
Description
American Specialty Health Incorporated is seeking a dynamic and engaging Practitioner Campaign Associate to join our team! This is an exciting opportunity support the practitioner recruitment team with prelaunch and execute campaigns, which includes working directly with telerecruiters, fielding incoming faxes, client and member nominations, and dissemination of credentialing documents to recruiters for follow up. This position plays an integral role in our company by expanding our network and supporting our mission to empower individuals to live healthier and longer.
Responsibilities
- Interfaces with prospective practitioner to encourage participation in our Clinical and Fitness programs.
- Makes outbound telephone calls to prospective practitioner to raise awareness of the programs, to set field appointments and provide follow up to assigned recruiter’s initial outreach in key campaigns.
- Initiates first time calls to practitioners in low profile campaigns.
- Invites practitioners to webinars, notifies them of upcoming seminars, and advises them of field appointments if requested by practitioner.
- Sends recruitment material to practitioners.
- Records contacts into the contact management database.
- Manages time to ensure the minimum required outbound calls per day and per week are met, as specified by management.
- Works off of daily and weekly call lists generated from database for key and on-going campaigns.
- Researches unique questions using all available sources. Refers difficult issues to Manager for appropriate answers.
- Handles incoming queue calls for absent reps as well as during high call volume in the department.
- Supports the recruitment team by conducting on-going internet searches when recruiters encounter disconnected and wrong numbers for clinical and fitness practitioners.
- Conducts data research for records in the Primus database that are determined to be inaccurate.
Qualifications
- Associates degree required or equivalent. High school diploma required.
- Minimum six months experience in outbound or inbound call environments and/or customer service.
- Strong verbal/telephone communication skills.
- Proficient in MS Office.
- Organized, results oriented team player, ability to work under time sensitive projects as directed by management.
- Demonstrates the ability to conduct outbound calls to clinical and fitness practitioners as follow up to recruiter’s initial outreach, to include coordination of field appointments.
- Ability to handle inbound calls as needed during high call volume times.
- The ability to field and handle typical objections and the ability to present information in a clear and concise manner utilizing campaign scripts.
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 speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions
Work-from-home (WFH) environment.
American Specialty Health is an Equal Opportunity/Affirmative Action Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
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. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.
ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access 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 access 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.
by twochickswithasidehustle | Oct 9, 2024 | Uncategorized
Description
American Specialty Health Incorporated is seeking a detail-oriented research representative for our Eligibility team. This position will research and resolve eligibility verification requests while providing the highest quality of customer service by maintaining a professional and courteous manner. The ideal candidate will have strong typing and 10-key skills while maintaining 98% accuracy. The research representative follows confidentiality guidelines to ensure security measures are enforced and proprietary information remains protected.
Remote Worker Considerations
Candidates who are selected for 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 remote/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 (minimum internet download of 50 Mbps and 10 Mbps upload speed).
Responsibilities
- Verifies member eligibility from the eligibility file, communications logs, and health plan websites or by calling the health plan directly when all other resources are exhausted.
- Inputs and saves verified member’s information into the communications log and/or member maintenance.
- Promptly processes and completes research to ensure turnaround times are met.
- Makes follow up calls to practitioners and members to provide research results.
- Builds or updates member and group records in ASH’s proprietary claims processing system including documentation in notes.
- Follows confidentiality guidelines to ensure security measures are enforced and proprietary information is protected
- Must maintain a minimum production level of 85 claims, 60 CSS/MNA, or 60 ASHLink requests per day pro-rata with no less than 98% accuracy.
- Ability to assist in multiple functions as needed.
- Ability to participate in peer mentorship as needed.
Qualifications
- High School Diploma required.
- Minimum one year experience with 10 key, typing, and computer skills. 7,000-10,000 key strokes per hour required.
- Excellent customer service skills, experienced in making outbound calls and meeting expectations for productivity and accuracy required.
- Experience with claims processing or eligibility verification preferred.
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 speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions
Work-from-home (WFH) environment.
by twochickswithasidehustle | Oct 9, 2024 | Uncategorized
Description
American Specialty Health Incorporated is seeking an experienced Client Audit Manager to join our Client Services – Clinical department. This position will provide support for client delegation (including pre-delegation) and regulatory compliance audits. The position also supports other delegation oversight compliance efforts, as well compliance-related inquiries/reviews, in consultation with the Sr. Manager, Delegation Support and Director, Clinical Client Services. The position also supports other compliance activities of the department related to internal compliance efforts.
Salary Range
American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications, education, skill set, years of experience, and internal equity. $48,000 to $55,000 Full-Time Annual Salary Range.
Remote Worker Considerations
Candidates who are selected for 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 remote/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 (minimum internet download of 50 Mbps and 10 Mbps upload speed).
Responsibilities
- Provides support related to complex delegation support activities in consultation with and under the direction of Sr. Manager, Delegation Support.
- Leads audits on behalf of ASH with assigned clients.
- Facilitates and leads internal and external meetings acting as owner of information. This includes creating and distributing meeting agendas, kicking off the discussion with a high-level overview and purpose of the meeting, introductions, and then closing the discussion with action items. This also includes facilitating and leading any internal preparation meetings and/or sending out details to the internal stakeholders prior to the meeting so they have enough information to prepare for their role in the discussion.
- Proactively engages internal customers and subject matter experts to effectively manage internal and external customer expectations.
- Seeks support from and provides client updates at internal committee meetings as appropriate.
- Travels, as directed by the Sr. Manager, Delegation Support, to support audits in locations other than the position’s designated ASH office location.
- Provides support for internal compliance activities, as needed, based on direction from Sr. Manager, Delegation Support.
- Actively participates in collaborative team environment to educate, coordinate activities, and resolve unique problems with recommended courses of action to internal stakeholders.
- Accepts and/or returns phone calls from clients within the same business day of receipt, Monday through Friday.
- At a minimum, acknowledges receipt of emails from clients within 24 hours of receipt.
- Maintains timely and accurate documentation of client interactions, activities, processes and issue resolution; ensures meeting minutes and action items are prepared and documented within two days of a client meeting as applicable.
- Ensures high level of service to meet client expectations on a daily basis.
- Communicates with Sr. Manager Delegation Support and Director, CTC, on high level issues to ensure appropriate response and resolution.
- Establishes and maintains positive professional relationships with internal and external customers.
- Interfaces with ASH staff to resolve issues, answer questions and triage responses.
- Schedules internal and external meetings to support audit initiatives as applicable.
- Acts as a back-up for other Delegation Support Managers.
- Maintains compliance with ASH policies and procedures.
- Seeks support and training from designated Delegation Support Manager II, Senior Delegation Support Manager, and/or Director, Client Services to aide in gaining the experience and skills required to advance to a Delegation Support Manager II.
- Maintains confidentiality of all reports, files, schedules, databases, and documents; as well as all member, provider, and proprietary information and ensures the Delegation Support team does the same.
- At the direction of the Sr. Manager, Delegation Support, communicates unique aspects of client delegation activities at various meetings with internal and external customers to support delegation functions.
- At the direction of the Sr. Manager, Delegation Support participates in activities related to internal and external process improvements.
- Manages compliance attestation requests from clients requiring Compliance Office signature, including keeping the Compliance Office informed of attestation requests and working with department staff and internal stakeholders to monitor and track requirements set forth in attestations, particularly new requests and requests not previously specified via contract with clients.
Qualifications
- Bachelor’s degree in in related field or equivalent experience. If equivalent experience, high school diploma required.
- Proficiency in MS Office with intermediate experience in Word, Outlook and Excel required.
- Experience in health care administration preferred but not required.
- Experience in managed care operations preferred but not required. Experience may include accreditation, account management, regulatory compliance, contract review,
- Proven experience and developed Customer Service skills required.
- Experience in project management, meeting facilitation and documentation required.
- Training or certification in health care beneficial but not 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 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 speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions
Work-from-home (WFH) environment.
American Specialty Health is an Equal Opportunity/Affirmative Action Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
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. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.
ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access 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 access to compensation information.
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