[Remote] Administrative Analyst (Remote)

Note: The job is a remote job and is open to candidates in USA. American Specialty Health Incorporated (ASH) is seeking an Administrative Analyst to join our Medical Necessity/Benefits Administration department. The primary purpose of this position is to generate, mail and track member service denial notifications in accordance with URAC, NCQA, CMS, DMHC and ASH standards.

Responsibilities

• Generates and mails member service denial notifications to members, health plans and practitioners
• Develops and maintains procedures related to member service denial processes
• Revises service denial letters as mandated by URAC, NCQA, CMS, DMHC and contracted health plans
• Revises service denial matrix as mandated by URAC, NCQA, CMS, DMHC and contracted health plans
• Coordinates workflow with MNA and CQE to ensure member service denial notifications are appropriately sent to members, health plans and practitioners
• Enters necessary information in the system to track service denials notifications
• Creates and submits member service denial logs to contracted health plans on a daily/monthly basis
• Reports and tracks service denial notifications turn-around time on a daily/monthly basis
• Ensures service denial notifications turn-around time standards are consistently met
• Maintains confidentiality of all member, provider, client and proprietary information
• Assists manager with special projects and reports as needed
• Assists supervisor (s) with administrative duties as needed
• Assist with the preparation of files for various audits
• Runs system queries and reports as needed
• Performs other duties as assigned
• Complies with all policies and standards

Skills

• High School Diploma or GED certificate required
• 2 years progressive experience performing administration duties. Internal experience at ASH required
• Proficient in MS Word, Excel and Access
• Demonstrated strong analytical and written communication skills
• Knowledge of Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC) regulations and related notifications helpful

Benefits

• 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.
• The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Company Overview