[Hiring] Eligibility Research Representative I @American Specialty Health Incorporated

Role Description

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. 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

• 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.
• 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.
• Processes research immediately to ensure same day turnaround time is met.
• Completes research and returns ASHCore log to MNA bucket.
• 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.
• 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.
• 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.

Requirements

• 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.