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

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
- 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.

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 c