Associate Operations Correspondence Analyst, DentaQuest

*
* Job Description:

*** 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 Senior Manager.
* 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 Senior Manager 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 Senior Manager 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 Denta Quest 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.
* Associate degree in business, healthcare or related field (or equivalent work experience)
* 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.
* 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…