Examiner I - Remote Position at $15/hour

About the Role

American Specialty Health Incorporated (ASH) is hiring an Examiner to become part of their Medical Necessity/Benefits Administration team. The central responsibility involves data entry from Medical Necessity Review Forms (MNR Forms) and Clinical Quality Evaluator (CQE) worksheets. Comprehensive training covers ASH company culture, standard operating procedures for Medical Necessity Administration (MNA), and instruction on using ASH software like IHIS, ASHCore, and ELIG.

Remote Work Requirements

This position is fully remote, requiring a dedicated workspace at home outfitted with company-provided technology. A stable internet connection is mandatory, with at least 50 Mbps download and 10 Mbps upload speeds, though 100 Mbps down/20 Mbps up is preferred to support quality video conferencing.

Key Responsibilities

• Enter data accurately from MNR Forms and CQE worksheets, achieving a minimum productivity of 20 MNR Forms per hour with 98% or higher quality standards.
• Perform front-end data entry tasks such as verifying completeness of forms, member eligibility, and creating patient records.
• Validate patient and provider details against records in the Integrated Health Care System (IHIS).
• Process data into IHIS per MNA protocols, including handling various denial categories like out-of-network or submission timeframe denials.
• Forward forms to Clinical Quality Evaluators for further medical necessity review.
• Conduct back-end data entry by retrieving patient records, reviewing CQE worksheets for completeness, and inputting data accordingly before forwarding to administrative staff.
• Utilize eligibility verification, form type identification, membership maintenance, and research tools such as ASHCore and Reports Manager.
• Conduct administrative duties including contacting providers for clarification, preparing daily reports, and other assigned tasks.
• Adhere to all organizational policies and standards.

Required Qualifications

• High school diploma or GED certificate.
• At least two years of experience in data entry with a minimum typing speed of 10,000 keystrokes per hour and proficient keyboard skills.

Core Competencies

• Ability to maintain respectful, positive interactions and develop effective working relationships.
• Strong customer service skills addressing both internal and external client needs.
• Excellent listening and interpersonal communication aptitudes.
• Effective organizational skills to multi-task, prioritize, and manage time efficiently.
• High level of accuracy and productivity despite frequent interruptions and changes.
• Analytical problem-solving capabilities applied to procedural or situational challenges.
• Commitment to maintaining strict confidentiality.

Physical and Environmental Conditions

• Primarily sedentary work requiring long periods of sitting.
• Ability to see, speak, and hear colleagues; communicate verbally and in writing.
• Capability for local travel within or around the work environment as needed.
• Use of telephone, computer keyboard, and mouse; ability to lift items up to 10 pounds.
• Work will be conducted from home under remote setup.

Equal Opportunity Employer Statement

American Specialty Health is an Equal Opportunity/Affirmative Action employer that values diversity irrespective of sex, gender identity, race, religion, disability, age, sexual orientation, veteran status, or other protected characteristics. Applicants with disabilities or disabled veterans may request reasonable accommodations by contacting Human Resources.