Eligibility Research Rep I

American Specialty Health Incorporated (ASH) is seeking a Research Representative to join our Eligibility department.

The primary function of this position is to research and resolve eligibility verification requests in an appropriate and timely manner.

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 (minimum 50 Mbps download and 50 Mbps upload speed.)

Responsibilities

• Researches and resolves member eligibility requests.
• Must maintain a minimum production level of 85 claims, 60 CSS/MNA, or 60 ASHLink requests per day pro-rata with no less than 98% accuracy.
• Ability to assist in multiple functions as needed.
• Ability to participate in peer mentorship as needed.

Eligibility Research Verification:

• Follows confidentiality guidelines to ensure security measures are enforced and proprietary information is protected.
• Verifies member eligibility from eligibility file, communications log, and health plan websites or by calling the health plan directly when all other resources are exhausted.
• Inputs and saves verified member's information into the communications log and/or member maintenance.
• Ensures the highest quality of customer service by maintaining a professional and courteous manner.

MNA Research:

• Processes research immediately to ensure same day turnaround time is met.
• Completes research and returns ASHCore log to MNA bucket.
• Customer Service Research:
• Processes research same day to ensure 24 hour turnaround time is met.
• Makes follow up calls same day to providers and members to give results of research.
• Transfers providers to provider queue if question is not related to eligibility.
• Transfers members to member queue if caller has detailed questions or wishes to file a complaint.
• Updates member and group records as needed.
• Resolves ASHCore log when process is completed.

Claims Research:

• Processes research within 24 hours to ensure 48 hour turnaround time is met.
• Builds or updates member and group records in IHIS including documentation in notes.
• Creates ASHCore log and resolves whenever a health plan call is made.
• Completes pend screen when research is completed.

ASHLink Research:

• Processes research within 24 hours to ensure 48 hour turnaround time is met.
• Creates ASHCore logs and resolves whenever a health plan call is made.
• Completes ASHLink logs by responding to providers when research is complete.
• Attends staff and other meetings to discuss issues and foster teamwork among department personnel.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• High School Diploma or GED certificate required.
• 1 year experience with 10 key, typing, and computer skills. 8,000 key strokes per hour required.
• Experience with claims processing or eligibility verification preferred.
• Excellent customer service skills, with experience making outbound calls and meeting expectations for productivity and accuracy.

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 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.