Correspondence Policy Specialist

What You’ll Be Doing

• Develops and customizes correspondence according to regulatory requirements and contractual requirements including coordinating Compliance Department approval for new and existing business.
• Provides oversight of the use of appropriate correspondence and review requests for new or modifications to existing correspondence templates.
• Oversees clinical correspondence for all products in collaboration with Compliance.
• Updates clinical correspondence templates as needed to ensure they meet the minimum standards for National Committee for Quality Assurance, Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS), and Company Policy across product lines and business segments.
• Tasked with problem solving and negotiation with internal and external customers around complex concepts and competing interests for risk mitigation and avoidance of Corrective Action Plans.
• Researches state regulatory requirements for clinical correspondence and policies using online technology and research tools.
• Consults with IT to support the letter generation process.

Qualifications

• 3+ years of healthcare industry experience.
• 3+ years of experience with compliance and quality requirements related to healthcare and UM processes.
• Associates preferred but consideration for 2 or more additional years of experience will be considered.
• Analytical/problem solving skills.
• Strong interpersonal, consultation, organizational, tracking and follow-up skills.
• Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
• Possesses excellent verbal and written communication skills.
• Knowledge of legislative/oversight bodies [e.g., National Committee for Quality Assurance Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS)]

Technical Requirements

• High speed internet over 10 Mbps.
• The ability to plug in directly to the home internet router for all call center employees.