Correspondence Policy Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Create and tailor clinical correspondence in alignment with regulatory and contractual stipulations.

• Facilitate the Compliance Department's authorization for both new and existing business correspondence.

• Manage the proper utilization of correspondence and evaluate requests for new or revised templates.

• Supervise clinical correspondence across all products in partnership with the Compliance team.

• Revise templates to comply with NCQA, URAC, ERISA, CMS, and company policy standards.

• Address issues and negotiate with both internal and external stakeholders regarding complex ideas and conflicting interests.

• Reduce risks and prevent the need for Corrective Action Plans.

• Investigate state regulatory prerequisites for clinical correspondence and policies utilizing online technologies and research tools.

• Collaborate with IT to enhance the letter generation process.

⛳️ Requirements

• A minimum of 3 years of experience in the healthcare sector.

• At least 3 years of expertise in compliance and quality mandates related to healthcare and Utilization Management processes.

• An Associate degree is preferred; alternatively, 2 or more years of additional experience may be considered.

• Proficient analytical and problem-solving abilities.

• Strong interpersonal, consultation, organizational, tracking, and follow-up capabilities.

• Capacity to research, gather, coordinate, and synthesize feedback and guidance from various operational groups and organizations into a cohesive written product.

• Exceptional verbal and written communication skills.

• Familiarity with legislative and regulatory bodies, such as NCQA, URAC, ERISA, and CMS is preferred.

• A government-issued photo ID is required for identity verification.

• A thorough background check is mandatory.

• In-person I-9 verification is required.

• Candidates may be subject to drug screening prior to employment.

• High-speed internet connection of over 10 Mbps is necessary at home.

• Ability to connect directly to the home internet router is required for call center employees.

• Use of AI tools is prohibited and monitored during the interview process.

🏝️ Benefits

• Work/life balance.

• Flexible work arrangements.

• Independence in completing work tasks.

• Health insurance benefits available for eligible employees.