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Performs verification and updates PROMIS according to standards and health plan expectations. Verifies with the appropriate agencies that the applicant has a current and valid license. Checks with the appropriate agencies to determine whether the applicant has had any sanctions against his/her license. Determines whether the applicant has had any Medicare or Medicaid sanc
Posted Today
Reconciles, resolves, and researches 2 step claims and payments to ASH. Manually reconciles claims for payment from Health Plan Payors received by paper EOBs or spreadsheets. Makes calls to Health Plans to check status of claims which may include payment or underpayment. In addition will request claims to be reprocessed if denied in error. Uses Health Plan and TPA website
Posted 5 days ago
Respond to and resolve fitness inquiries received via the Fitness Contract Services queue. Answers at least 75% of incoming calls in less than 30 seconds from fitness queue. Assists fitness center staff with questions regarding participation requirements, contractual issues, and high level administrative problems. The ability to assume/take over escalated fitness related
Posted 6 days ago
Provides support related to complex delegation support activities in consultation with and under the direction of Sr. Manager, Delegation Support. Leadsaudits on behalf of ASH with assigned clients. Facilitatesand leads internal and external meetings acting as owner of information. This includes creating and distributing meeting agendas, kicking off the discussion with a
Posted 6 days ago
Interfaces with various practitioner types to promote American Specialty Health and to execute practitioner contracts. Makes outbound telephone calls to prospective practitioner types. Meets the minimum required outbound calls per day and per week, as specified by management. Utilizes contact management database. Adheres to standards and practices as outlined in the Pract
Posted 6 days ago
Maintains existing and develops new mapping across a variety of file types, manages inbound file/data processing, develops new files/reports. Manages a range of EDI transactions including enrollment, benefits, claims, and financial transactions. Independently develops mapping and translations between data elements for file feeds. Leads the implementation of EDI connection
Posted 11 days ago
Interfaces with various clinical practitioner types to promote ASH and to execute practitioner contracts for key health plan clients to support relationships and to provide delivery system updates. Maintain ongoing focus for productivity in a fast paced environment and meets deadlines in an environment where priorities may change. Ability to display effective presentation
Posted 11 days ago
Provides administrative support of ADA, Leave of Absence (LOA) and Workers Compensation Processes Reads and responds to employees' questions and requests via the LOA email inbox throughout the day. Ensures that employees are aware of their responsibilities and of any documentation and notice required to qualify for and to take leave. Supports the FMLA leave administration
Posted 13 days ago
Leading a portion of a growing DevSecOps engineering team. Develops project plans, specifying goals, strategies, resource allocation, and scheduling. Coordinates activities of DevSecOps engineers to ensure goal achievement within identified timeframes. Researches and evaluates technology and processes; makes recommendations to improve team performance, productivity, and s
Posted 17 days ago
Quality Assurance for Production Activity, Collect Data, and Produce Routine Reporting. Audit completed job tickets ensuring job instructions are properly documented and jobs are completed as requested. Provide quality assurance feedback for production, assembly, and validation teams for coaching and continuous process improvement. Performs night close including review an
Posted 18 days ago
Creates pricing proposals, RFP responses, and other assignments. Collaborates with all levels of the company including sales, management, and executive leadership to develop custom pricing proposals and RFP responses for health plans, brokers, employer groups, TPAs, and/or other requestors. Maintains accurate file information for each assignment using established guidelin
Posted 18 days ago
Plans and coordinates the production of virtual corporate meetings and events. Responsible for the production of virtual corporate meetings and events in support of internal and external business objectives. Leads the planning and production of the monthly all staff video, including creating an annual calendar of recurring segments, such as quarterly awards and executive
Posted 18 days ago
Answer incoming calls in a professional, accurate, timely and courteous manner. Ascertain the nature of the call and record information in the Communication Log. Look up member information using proprietary ASH systems and provide information to the caller. Forward logs requiring further research to the appropriate department. Transfer callers to the appropriate queue if
Posted 19 days ago
Outreach and educate contracted practitioners to ensure compliance is met. Conduct regular Access to Care Surveys to ensure compliance with regulatory and health plan requirements. Outreach to practitioner network of practitioners who have not validated their demographics in order to meet regulatory requirements. Conduct audit to confirm current directory listing informat
Posted 21 days ago
Respond to and resolve fitness inquiries received via the Fitness Contract Services queue. Answers at least 75% of incoming calls in less than 30 seconds from fitness queue. Sends requests that require research on complex issues to Lead Fitness Contract Services Rep to achieve appropriate resolution. Captures fitness complaints and resolves or forwards to Fitness Contract
Posted 25 days ago
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