Eligibility Research Rep I (remote, $15/hr) - Remote Eligible

Research Representative

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: 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.