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Data Entry and Virtual Assistance

Examiner I (Remote, $15/hour) Full Time

Summary:

American Specialty Health Incorporated is seeking a Data Entry Examiner to support the Medical Necessity/Benefit Administration Department. This remote position requires the candidate to enter data from Medical Necessity Review Forms and Clinical Quality Evaluator worksheets.

Responsibilities:

  • 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 with 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.

Requirements:

  • High School diploma required.
  • 2 years data entry experience (10,000 keystrokes per hour – minimum) and working knowledge of the computer keyboard.
  • 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.

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