Examiner I

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.


· 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.


· 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.


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.