Job Description

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.

Hourly Salary Range American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications, education, skill set, years of experience, and internal equity. $16.36 to $17.00 Hourly Wage Range.
Remote Worker Guidelines

• 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.

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
• Provides administrative support
  • 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.

Qualifications

• High School Diploma or GED certificate required.
• 2 years progressive experience performing administrative duties. Internal experience at ASH required.
• Proficient in MS Word, Excel and Access.
• Knowledge of Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC) regulations and related notifications helpful.
• Demonstrated strong analytical and written communication skills.

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 see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCP here

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

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