Administrative Analyst, MNA

Administrative San Diego, California


Description

American Specialty Health Incorporated is seeking an Administrative Analyst to join our Medical Necessity department. This position will 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
  • Provides administrative support
  • 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.

Qualifications

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

COVID-19 Considerations:

The safety of our employees, both current and future, is ASH’s highest priority. At this time, most of our employees are working remotely due to the current COVID-19 pandemic. 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. Once ASH determines employees can return to the office, candidates may be required to work in a local office. Limited visits to the office in person may be required. While onsite, social distancing and masks are required along with adherence to ASH’s Communicable Disease and Pandemic Policy.

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 speak, see and hear other personnel and/or objects.  Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local 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.