Employer: American Specialty Health
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.
Â· 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.
Â· Reviews MNR forms to be sure all information is complete. Verifies member eligibility and creates patient records.
Â· Checks patient and provider information on MNR Forms against information on the eligibility tape in the Integrated Health Care System (IHIS).
Â· 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.
Â· Forwards MNRs to the Clinical Quality Evaluators’ designated bins for clinical review.
Â· Retrieves patient files or history for the CQEs as necessary.
Â· Reviews CQE’s worksheets to make sure they are complete.
Â· Inputs all required data from worksheets into Integrated Health Care System (IHIS).
Â· Processes CQE worksheets in accordance to the MNA guidelines.
Â· Forwards worksheets to the Administrative Support staff for final processing.
Â· Demonstrates proficiency in eligibility verification, provider verification, identifying and pre-screening different form types.
Â· Add new members and sequence numbers in Member Maintenance.
Â· Researches via CHIP logs.
Â· Performs production query via Access.
Â· Forwards eligibility research to Membership.
Â· Process Duplicate request.
Â· Contact provider’s office to clarify missing or illegible information on the MNR forms.
Â· Completes daily tally sheets and production reports for Supervisor.
Â· High School diploma required.
Â· 2 years data entry experience (10,000 keystrokes per hour – minimum) and working knowledge of the computer keyboard.
Â· Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
Â· Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
Â· Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
Â· Ability to effectively organize, prioritize, multi-task and manage time.
Â· Demonstrated accuracy and productivity in a changing environment with constant interruptions.
Â· Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
Â· Ability to exercise strict confidentiality in all matters.
Primarily sedentary, able to sit for long periods of time.
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.
Work-from-home (WFH) environment.