Clinical Proofreader/Editor

Key Responsibilities

• Complete assigned correspondence tasks promptly and within designated timeframes.
• Identify gaps in processes and provide actionable feedback to reduce errors and improve overall quality.
• Review member and provider communications to ensure consistency with the clinical system (TruCare) and compliance with regulatory guidelines.
• Audit and analyze correspondence to confirm accuracy with TruCare records and ensure the appropriate templates are utilized correctly.
• Work closely with care managers, leadership, and peer reviewers to maintain compliance with regulatory-mandated communications.
• Assess correspondence for accurate medical terminology and adherence to departmental policies and applicable regulations.
• Support the organization in managing the lifecycle of correspondence, including creation, storage, secure retrieval, and proper archiving.
• Maintain consistency in all correspondence by adhering to corporate branding standards.
• Take on other responsibilities as assigned.

Qualifications

• Possession of a high school diploma or equivalent (GED).
• Exceptional skills in both written and verbal communication.
• Strong abilities in organization and time management.
• Ability to meet production targets of 35 letters per day and 200 letters per week.
• Proven critical thinking and creative problem-solving capabilities.
• Relevant professional experience within the healthcare industry.
• An associate degree in a healthcare-related field is preferred.
• Working knowledge of MS SharePoint.
• Hands-on experience with Utilization Management, government healthcare programs, and managed care processes, including organizational determinations, approvals, denials, appeals, and grievances.
• Adept at performing moderately complex communication tasks, with experience in training others and collaborating across teams.
• Demonstrated adaptability to evolving tasks and a professional, objective approach to collaboration.

Pay

Starting at $25+/HR

Schedule

Regular Hours: Monday-Friday, 11:00 AM to 8:00 PM (ET)