You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.
DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.
Job Description:
JOB SUMMARY:
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The Operations Correspondence Analyst is part of the Operations Compliance team, reporting to the Operations Correspondence & Support Supervisor. Implements and maintains the templates utilized for correspondence required based on operational activity and driven by requirements defined by federal/state regulation, NCQA and URAC.PRIMARY JOB RESPONSIBILITIES:
- Manage efforts to implement and revise correspondence, resulting from operation activity for utilization management, claims, and complaints/grievance/appeals, to ensure accurate content within the templates and the templates are implemented or revised within the timelines required.
- Completion of the client requirement document (CRD) to accurately reflect contract and regulatory requirements.
- Presentation of the CRD content to the client. Coordinate revisions necessary to final completion and client approval.
- Identify the templates required for implementation, based on operational process and requirements. Draft a template document, as necessary.
- Ensure template content meets requirements based on client contract, regulations, NCQA and/or URAC.
- Perform gap analysis for correspondence requirements and system functionality and/or current process and develop strategic solutions to ensure compliance with requirements.
- Coordinate template implementation and revisions with the client, client services, operations, the correspondence technical team and the Operations Correspondence & Support Supervisor.
- Define the rules necessary to accurately populate variable information within the template. Communicate the rules effectively to the correspondence technical team.
- Mock up samples of the templates and submit to the correspondence technical team to draft production samples. Define the parameters to be utilized to produce the samples, when necessary. Review production samples provided to ensure accuracy.
- Obtain approval from the client of the production samples. Coordinate through client services, as necessary.
- Coordinate production of the template with the correspondence technical team after approval has been received.
- Coordinate with the Operations Correspondence & Support Supervisor to create cases to test triggers for templates for complaint/grievance/appeals.
- Obtain translation of template content into non-English language(s), as necessary.
- Audit production samples of the letter files once the template is put into production.
- Communicate all template implementation and revisions to the applicable operational department.
- Audit templates periodically to ensure most recent approved template is in production.
- Assist the Operations Correspondence & Support Supervisor to determine root cause for all findings identified in an external audit, relating to correspondence.
- Correct errors identified by the UM Administrative Coordinators relating to mapping to citations and member denial language.
- Create and maintain a letter library and tracking mechanism for all current and historical templates for each client. Documentation to include client approval and the version of the template that is approved.
- Complete the process for Notice of Action (NOA) letters that require modification prior to mailing to the member to ensure modifications completed are accurate and completed timely.
- Cultivate and maintain professional relationships with both internal and external customers; communicate effectively with both internal and external customers using various methods of communication, including email, conference call, and video conferencing.
- Demonstrate a detailed understanding of requirements for correspondence for operations, as listed in individual client contracts and in federal and/or state regulations.
- Demonstrate a detailed understanding of DentaQuest policies and processes for correspondence for operations.
- Participate in market meetings to understand client requirements and changes. Communicate any items that impacts correspondence.
- Other duties as needed or required.
JOB QUALIFICATIONS:
Required:
- Associate’s degree in business, healthcare or related field (or equivalent work experience)
- 3 years’ experience in a healthcare related field
- Proficient with general computer software including Microsoft Excel, Word and Outlook.
- Exceptional communication skills and the ability to communicate appropriately at all levels of the organization. This to also include the ability to communicate appropriately with external customers, including clients and/or regulatory agencies.
- Excellent spirit for teamwork, problem-solving, communication, and decision-making skills.
- Strong situational analysis and decision making abilities.
- Excellent verbal, written, interpersonal, organizational and public speaking/communication skills. Able to effectively communicate visualizations.
- Ability to prioritize and organize multiple tasks with tight deadlines.
- Ability to manage multiple projects and priorities in a fast-paced, result-driven environment.
- Excellent independent problem solving skills
- Self-motivated and has the ability to work with little supervision and make independent decisions.
- Demonstrated track record of attention to detail.
- Required to attend additional training as requested/deemed necessary.
Preferred:
- Minimum 3 years demonstrated experience managing multiple complex tasks with varying deadlines and competing priorities.
- Ability to work closely with internal business partners to ensure project completion.
- Previous experience managing template documents.
- Demonstrated experience managing relationships with internal/external customers and working closely with the external customer to implement processes.
PHYSICAL DEMANDS:
- Ability to use basic office equipment and communicate via phone, computer technology, and via written and verbal channels.
- Ability to communicate in an active office environment, including moderate voice levels and interruptions, which may challenge hearing and concentration.
- Ability to sit for extended periods of time.
- Ability to work extended hours, as dictated by various State contractual agreements. May include weekends and holidays.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform this position.
** In accordance with DentaQuest’s Compliance Plan, employee must conduct DQ business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or DQ’s Compliance Officer. **
DentaQuest’s Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program.
Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email recruitingUS@sunlife.com to request an accommodation.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran
