The primary function of this position is to enter data from Medical Necessity Review Form (MNR Form) and Clinical Quality Evalutor (CQE) worksheets. Training on ASH Company Culture and Values;MNA Department SOPs; IHIS, CHIP, ELIG, Other ASH Company Software Applications; Processing requirements for Medical Necessity Review Forms.
· Enters data from MNR Form and/or CQEworksheets. 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 MNRss to the Clinical Quality Evalutor’s designated bins for clinical review.
Back-end data entry:
· Retrieves patient files or history for the CQEs asnecessary.
· 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
· A dd new members and sequence numbers in Member Maintence
· Researches via CHIP logs
· Performs production query via Access
· 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 and responsibilities as assigned.
· High School diploma or equivalent.
· Minimum two years data entry experience (10,000 keystrokes per hour - minimum) and working knowledge of the computer keyboard.
· 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 oral 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 . Moderate noise from office equipment (copiers, fax, keyboards) and minor distraction from conversations (telephone and general office).