Employer: American Specialty Health
Description
American Specialty Health Incorporated is seeking a Data Entry Examiner to support our Medical Necessity/Benefit Administration Department. This position is responsible for entering data from Medical Necessity Review Form (MNR Form) and Clinical Quality Evaluator (CQE) worksheets.
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.
Responsibilities
· Enters data from MNR Form 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.
· Reviews MNR forms to be sure all 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 all required data from MNR forms into Integrated Health Care System (IHIS) in accordance with MNA guidelines; including but not limited to Out of Network: Administrative Partial and Complete Denials; submission Timeframe Denials and Network Access Denials.
· Forwards MNRs to the Clinical Quality Evaluators’ designated bins for clinical review.
· Retrieves patient files or history for the CQEs as necessary.
· Reviews CQE’s worksheets to make sure they are complete.
· Inputs all required data from worksheets into Integrated Health Care System (IHIS).
· Processes CQE worksheets in accordance to the MNA guidelines.
· Forwards worksheets to the Administrative Support staff for final processing.
· Demonstrates proficiency in eligibility verification, provider verification, identifying and pre-screening different form types.
· Add new members and sequence numbers in Member Maintenance.
· Researches via CHIP logs.
· Performs production query via Access.
· Forwards eligibility research to Membership.
· Process Duplicate request.
· Contact provider’s office to clarify missing or illegible information on the MNR forms.
· Completes daily tally sheets and production reports for Supervisor.
Qualifications
· High School diploma required.
· 2 years data entry experience (10,000 keystrokes per hour – minimum) and working knowledge of the computer keyboard.
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.