by twochickswithasidehustle | Oct 9, 2024 | Uncategorized
locationsRemotetime typeFull timeposted onPosted 7 Days Agojob requisition idR6485
Are you looking to accelerate your career without having to hide your authentic self – a place where you can be you? A career that’s making a bigger impact on the world? At OneDigital, we are on a mission to help people do their best work and live their best lives. From the services we offer to the way we show up for each other each day, we are fueling dreams, achieving big goals, and embracing each other’s truest selves.
We understand that pursuing a new job is a big deal. Maybe you’re afraid you won’t fit in. Well, here’s the good news. For us, the days of “fit in to get in” are over and being different is not a barrier to getting ahead. Greatness comes in all shapes, sizes, colors, and experience levels. If you are looking for a people-first culture that is wired for growth, driven to serve, and totally committed to having your back, give us a shot. Your best life awaits.
Our Newest Opportunity:
The Client Advocate will utilize advanced insurance skills to provide favorable relationships with customers, groups and clients through the prompt, accurate and courteous resolution of benefit and eligibility inquiries.
Essential Duties and Responsibilities (include but are not limited to):
- Process all incoming enrollment, claims, billing and eligibility questions. This includes but is not limited to emailing/faxing the document to the carrier, entering information into the carrier website, completing carrier spreadsheets or processing the transaction over the phone with the carrier contact.
- Scrub all applications and identify situations where clarification needs to be made that could have an adverse effect on the eligibility for a participant (missing information) and follow-up with appropriate parties, including escalation if necessary.
- Responsible for resolving escalated issues such as urgent enrollments, unexpected pharmacy disputes, exception requests, complex claims and billing situations, as well as other unplanned eligibility matters that may come up from time to time. This may require extra communication as well as additional research into group history. Extensive noting of the account may be required.
- Provide customers with information and advice necessary to make insurance decisions for their families and provide issue resolution on plan options and plan selections.
- Provide coaching and mentoring for all members of the Client Advocate Center team.
- Responsibilities also include Client Advocate Center Specialist duties as needed.
Qualifications, Skills and Requirements:
- Professional phone etiquette and a pleasant tone;
- Must have a positive attitude and excellent verbal and written communication skills;
- Ability to thrive in a fast-paced environment without constant supervision and direction;
- Ability to accept both positive feedback and constructive criticism;
- Reliability and punctuality is a must;
- Current active Health & Life license is required.
Education, Training and Experience:
- Minimum three years of customer service experience required in a broker or insurance carrier setting; 5 years is preferred;
- Advanced knowledge of medical insurance and the ability to communicate information to customers;
- MS office experience and computer savvy. Able to navigate through different carrier websites without detailed training.
The typical base pay range for this role nationwide is $24 to $26 per hour.
Your base pay is dependent upon your skills, education, qualifications, professional experience, and location. In addition to base pay, some roles are eligible for variable compensation, commission, and/or annual bonus based on your individual performance and/or the company’s performance. We also offer eligible employees health, wellbeing, retirement, and other financial benefits, paid time off, overtime pay for non-exempt employees, and robust learning and development programs. You will receive reimbursement of job-related expenses per the company policy and may receive employee perks and discounts.
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.
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