esponsibilities
- 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.
