Note: The job is a remote job and is open to candidates in USA. American Specialty Health Incorporated (ASH) is seeking an Administrative Analyst to join our Medical Necessity/Benefits Administration department. The primary purpose of this position is to generate, mail and track member service denial notifications in accordance with URAC, NCQA, CMS, DMHC and ASH standards.
Responsibilities
- Generates and mails member service denial notifications to members, health plans and practitioners
- Develops and maintains procedures related to member service denial processes
- Revises service denial letters as mandated by URAC, NCQA, CMS, DMHC and contracted health plans
- Revises service denial matrix as mandated by URAC, NCQA, CMS, DMHC and contracted health plans
- Coordinates workflow with MNA and CQE to ensure member service denial notifications are appropriately sent to members, health plans and practitioners
- Enters necessary information in the system to track service denials notifications
- Creates and submits member service denial logs to contracted health plans on a daily/monthly basis
- Reports and tracks service denial notifications turn-around time on a daily/monthly basis
- Ensures service denial notifications turn-around time standards are consistently met
- Maintains confidentiality of all member, provider, client and proprietary information
- Assists manager with special projects and reports as needed
- Assists supervisor (s) with administrative duties as needed
- Assist with the preparation of files for various audits
- Runs system queries and reports as needed
- Performs other duties as assigned
- Complies with all policies and standards
Skills
- High School Diploma or GED certificate required
- 2 years progressive experience performing administration duties. Internal experience at ASH required
- Proficient in MS Word, Excel and Access
- Demonstrated strong analytical and written communication skills
- Knowledge of Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC) regulations and related notifications helpful
Benefits
- Remote Worker Guidelines: 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 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.
- The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.
Company Overview