California,Indiana, Kentucky, Arkansas, Delaware, Alabama, New Hampshire, Vermont, District Of Columbia, Wisconsin, Nevada, West Virginia, Hawaii, Idaho, Rhode Island, South Dakota, Minnesota, Mississippi, Missouri, Massachusettes, Michigan, Mayland, New Jersey, Pennsylvania, New York, Nevada, Ohio, Tennessee, Texas, Wisconsin, Washington, Georiga, North Carolina, Illinois, South Carolina, Virginia Utah, Oregon, New Mexico, wages starts @$15.00 per hr.
American Specialty Health Incorporated (ASH) is one of the nation’s premier independent and privately-owned specialty health organizations offering technology-enabled benefits management services, including musculoskeletal health provider networks and programs, fitness center networks and exercise programs, and health management solutions for health plans, insurance carriers, employers and others. Read employee reviews here
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.
Responsibilities
Answer incoming calls in a professional, accurate, timely and courteous manner.
Ascertain the nature of the call and record information in the Communication Log.
Look up member information using proprietary ASH systems and provide information to the caller.
Forward logs requiring further research to the appropriate department.
Transfer callers to the appropriate queue if the question is of a more complex issue (claims, authorizations, etc).
Utilize appropriate resources, including those online; to provide timely responses.
Manage time to ensure calls are answered within required timeframes and appropriate follow-up is done in a timely manner.
Meet or exceed minimum key job accountabilities established for the Customer Service Representative position.
Document all calls appropriately.
Attends weekly staff and other meetings to discuss issues and foster teamwork among department personnel.
Responds to requests for internal and external customers and/or clients, as required.
Qualifications
High school diploma or equivalent required.
Minimum of one year of experience performing customer service duties; inbound call center experience preferred.
Basic computer skills.
Strong verbal communications 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 .
Description
American Specialty Health Incorporated is seeking a Customer Service Representative to join our Customer Service Health Management team. The primary purpose of this position is to provide customer service to members who are seeking or utilizing Health Management programs.
Starting pay at $15.00/hour and the opportunity to earn up to $16.00/hour plus merit. Additional bonus opportunities based on performance after 6, 12, and 24 months.
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.
Responsibilities
Receives and responds to telephone calls from members, and health plans/employer groups.
Demonstrates knowledge and understanding of all ASH products and programs through consistent proficiency in quality, quantity, and responsiveness.
Responsive to customer contacts in a professional, accurate, timely and courteous manner.
Ascertains the nature of the contact and records information in the appropriate system.
Provides accurate answers to member inquires by following standard policies and procedures.
Interacts in a positive, respectful manner and establishes and maintains cooperative working relationships with internal and external customers.
Utilizes defined criteria to determine member qualification for Health Management programs.
Coordinates collection of necessary information, including member co-pays or payments when necessary.
Coordinates access to Health Management coaches when clinical advice or information is necessary to support the member.
Coordinates appointment scheduling for applicable Health Management programs and initiates appointments on behalf of Health Management coaches.
Forwards documentation to Research Team for follow up if inquiry requires additional action.
Analyzes information, problems, issues, situations and procedures to develop effective solutions to ensure member satisfaction with the Health Management programs.
Researches unique questions using all available resources. Refers difficult issues to Supervisor for appropriate answers.
Handles all issues requiring additional action within the necessary timeframes.
Manages time to ensure calls are answered within required timeframes and appropriate follow up is conducted in a timely manner.
Exercises strict confidentiality in all matters relating to the member experience with Healthyroads.
Attends and participates in employee and other meetings to discuss issues and foster teamwork among department personnel.
Places outbound outreach calls to members who were referred to the program by Health Advocates, DM, or other identified referral source when requested.
Qualifications
High school diploma or equivalent required.
Minimum 1 year Customer Service experience; with at least 6 months Customer Service experience in an inbound Customer Service Call Center servicing members.
Experience in healthcare preferred.
Basic experience with MS Office.
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.
American Specialty Health is searching for exceptional customer service professionals to join our high-volume call center to assist our members by providing exceptional customer service nationwide for our Fitness Programs. By responding to customers’ inquiries and providing information regarding all aspects of the members’ association with ASH, this position will play an integral role in supporting our company’s mission to empower individuals to live healthier and longer.
Responsibilities
Demonstrates knowledge and understanding of all ASH Fitness products and programs.
Answers incoming calls on the ASH telephone system in a professional, accurate, timely and courteous manner.
Ascertains the nature of the call and records information in the appropriate system.
Provides answers to member questions by following standard policies and procedures.
Interacts in a positive, respectful manner and establishes and maintains cooperative working relationships with internal and external customers.
Coordinates collection of the necessary information, including member co-pays or payments when necessary.
Forwards documentation to Research Team for follow-up if the issue requires additional action.
Analyzes follow-up information, problems, issues, situations, and procedures to develop effective solutions to ensure member satisfaction with the Fitness programs.
Researches unique questions using all available resources. Refers difficult issues to Supervisor for appropriate answers.
Handles all issues requiring additional action within the necessary timeframes.
Manages time to ensure calls are answered within required timeframes and appropriate follow up is conducted in a timely manner.
Exercises strict confidentiality in all matters relating to the member experience with the Fitness program.
Attends and participates in meetings to discuss issues and foster teamwork among department personnel.
Responds to requests from other ASH department personnel, contacting clubs and members as required.
Qualifications
High school diploma or equivalent required.
One-year experience performing customer service duties; inbound call center experience preferred.
Experience in healthcare preferred.
Basic experience with MS Office.
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.
Description
American Specialty Health Incorporated is seeking a Data Entry Examiner to support our Medical Necessity/Benefits Administration Department. This position is responsible for entering data from the Medical Necessity Review Form (MNR Form) and Clinical Quality Evaluator (CQE) worksheets.
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment. ASH requires all onsite employees and employees who travel for their position to either (a) establish that they have been fully vaccinated, or (b) obtain an approved exemption as an accommodation.
Responsibilities
· Enters data from MNR Form and/or CQE worksheets. The 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
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.
Responsibilities
Reviews all incoming claims to verify necessary information.
Maintains all required documentation of claims processed and claims on hand.
Maintains production standard; processes an average of 31 claims per hour, with an accuracy rate of 98.5%.
Provides backup for other examiners within the department and assists in the training of new claims personnel.
Attends organizational meetings as required, organizational policies and procedures and maintains confidentiality of all claims files, claims reports, and claims-related issues.
Qualifications
High school diploma required.
Data entry experience with 10 key and word processing; minimum 10,000 keystrokes per hour required.
Experience processing medical claims and knowledge of medical billing terminology and coding are strongly preferred.
Proficient in MS Office.
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.
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.
Responsibilities
Processes reimbursement requests accurately and efficiently.
Reviews all incoming reimbursement requests to verify necessary information.
Enters reimbursement requests and information into a computerized request Processing System.
Maintains all required documentation of reimbursement requests processed and reimbursement requests on hand.
Adjudicates reimbursement requests in accordance with departmental policies, procedures, state and accreditation standards, and other applicable rules.
Maintains minimum production standard, 98.5%.
Provides backup for other examiners within the department.
Promotes a spirit of cooperation and understanding among all personnel.
Attends organizational meetings as required.
Adheres to organizational policies and procedures.
Maintains confidentiality of all files, reimbursement request reports, and reimbursement request-related issues.
Qualifications
High school diploma required.
10 key and word processing; minimum 10,000 keystrokes per hour required with 95% accuracy.
Data Entry Experience.
Proficient in MS Office.
Ability to recognize unique and/or problem situations and brings to the attention of the Supervisor.
Demonstrated ability to meet department performance standards and quality improvement processes.
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.
Responsibilities
Reconciles resolves and researches ASO payments to ASH.
System reconciles ASO claims payment from Health Plan Payors.
Makes calls to Health Plans to check status of payment or underpayment. Make courtesy calls to Providers as needed
Makes calls and researches overpayment requests from health plan recovery services.
Documents follow-up in Reconciliation System or Communication Log.
Prepares letters of explanation to Health Plans and prepares spreadsheet documentation of payments/overpayments/underpayments.
Completes check requests for reimbursements of overpayments to Health Plans.
Maintains confidentiality of all claims documents, records, and claims-related issues.
Promotes a spirit of cooperation and understanding among all personnel.
Recognizes unique and/or problem situations within the area of assigned responsibility. Researches and makes recommendations to Supervisor.
Qualifications
High School diploma required.
2 to 3 years with claims processing, computer, typing, 10 key, and telephone skills preferred.
1-2 years experience as a Reconciliation Representative preferred.
Knowledge of Microsoft Word and Excel is helpful.
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