检查员 I（远程，15美元/小时）
Examiner I (Remote, $15/hour)
美国专业健康公司（ASH）正在寻找一名审查员加入我们的医疗必要性/福利管理部门。
该职位的主要职责是从医疗必要性审查表（MNR 表单）和临床质量评估员（CQE）工作表中录入数据。需接受关于 ASH 公司文化与价值观；MNA 部门标准操作流程（SOP）；IHIS、ASHCore、ELIG 以及其他 ASH 公司软件应用的培训；以及医疗必要性审查表的处理要求。
远程工作者指南
· 远程工作者指南：该职位将进行远程培训，必须能够在指定的工作区域使用公司提供的技术设备在家办公（WFH）。该 WFH 职位要求您拥有稳定的互联网服务提供商连接，并能够通过可靠且稳定的网络参与视频在线会议。网络连接必须保证最低 50 下载/10 上载 Mbps 的速度。建议为 100 下载/20 上载 Mbps，以支持更高质量的视频会议。
职责
- 从 MNR 表单和/或 CQE 工作表中录入数据。员工必须保持每小时至少处理 20 张 MNR 表单的生产量，并保持质量在 98.0% 或以上。员工必须按要求处理一定数量的后端治疗表单。前端数据录入：
- 审核 MNR 表单，确保所有信息完整。验证会员资格并创建患者记录。
- 将 MNR 表单上的患者和提供者信息与集成医疗系统（IHIS）中的资格磁带信息进行核对。
- 按照 MNA 指南将 MNR 表单的所有必要数据输入到集成医疗系统（IHIS）中。
- 包括但不限于：非网络内：行政部分和完全拒绝。
- 提交时间范围拒绝。
- 网络访问拒绝。
- 将 MNR 发送给临床质量评估员进行医疗必要性验证。
- 后端数据录入：
- 根据需要获取患者文件或病史供 CQE 使用。
- 审核 CQE 的工作表，确保其完整。
- 按照 MNA 指南将工作表中的所有必要数据输入到集成医疗系统（IHIS）中。
- 按照 MNA 指南处理 CQE 工作表。
- 将工作表转发给行政支持人员进行最终处理。
- 其他审查员技能/任务
- 展示在资格验证、提供者验证、识别和预筛选不同表单类型方面的熟练技能。
- 添加新患者记录
查看英文原文
American Specialty Health Incorporated (ASH) is seeking an Examiner to join our Medical Necessity/Benefits Administration department.
The primary function of this position is to enter data from Medical Necessity Review Form (MNR Form) and Clinical Quality Evaluator (CQE) worksheets. Training on ASH Company Culture and Values; MNA Department SOPs; IHIS, ASHCore, ELIG, Other ASH Company Software Applications; Processing requirements for Medical Necessity Review Forms.
Remote Worker Guidelines
· 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.
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.Front-end data entry:
- 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.
- Network Access Denials.
- Forwards MNRs to the Clinical Quality Evaluators’ for medical necessity verification.
- Back-end data entry:
- 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 to the MNA guidelines.
- Forwards worksheets to the Administrative Support staff for final processing.
- Additional Examiner Skills / Tasks
- 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 ASHCore logs.
- Performs production query via Reports Manager.
- Forwards eligibility research to Membership.
- Process Duplicate request.
- Administrative Duties
- Contact provider’s office to clarify missing or illegible information on the MNR forms.
- Completes daily tally sheets and production reports for Supervisor.
- Performs other duties as assigned.
- Complies with all policies and standards.
Qualifications
- High School Diploma or GED certificate required.
- 2 years of data entry experience (10,000 keystrokes per hour - minimum) and working knowledge of the computer keyboard required.
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.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.
ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.
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Originally posted on Himalayas