Administrative Analyst (Remote)

American Specialty Health is seeking an Administrative Analyst to join their Medical Necessity/Benefits Administration department. The primary purpose of this role is to generate, mail, and track member service denial notifications in accordance with various standards, while also providing administrative support as needed.

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

Requirements:

• High School Diploma or GED certificate required
• 2 years progressive experience performing administrative duties. Internal experience at ASH required
• 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