Correspondence Policy Specialist

Emploi pas sur LinkedIn

🕒 il y a 13 jours

🇺🇸 États-Unis – Télétravail

💵 $25 / heure

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

🦅 Parrain de Visa H1B

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👻 Score fantôme 0%

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🗣️🇺🇸🇬🇧 Anglais requis

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Logo of Evolent

Evolent

1001 - 5000 employés

⚕️ Assurance santé

🏥 Santé

☁️ SaaS

Healthcare Insurance • Healthcare • SaaS

Evolent est une entreprise de santé axée sur l'amélioration des résultats de soins grâce à ses solutions de gestion complètes couvrant plusieurs spécialités médicales. Elle vise à améliorer le parcours de soins des patients en offrant des services coordonnés dans des domaines tels que l'oncologie, la cardiologie, les troubles musculosquelettiques et les soins primaires, tout en veillant à garantir des parcours de traitement de haute qualité et une gestion des coûts. Evolent croit que chaque personne mérite des soins de qualité, s'efforçant d'aligner les lignes directrices du traitement et les approches innovantes pour répondre efficacement aux besoins des patients.

Description

• Develop and customize clinical correspondence according to regulatory and contractual requirements • Coordinate Compliance Department approval for new and existing business correspondence • Oversee appropriate correspondence use and review requests for new or modified templates • Oversee clinical correspondence for all products in collaboration with Compliance • Update templates to meet NCQA, URAC, ERISA, CMS, and company policy standards • Solve problems and negotiate with internal and external customers regarding complex concepts and competing interests • Mitigate risk and avoid Corrective Action Plans • Research state regulatory requirements for clinical correspondence and policies using online technology and research tools • Consult with IT to support the letter generation process

🎯 Exigences

• 3+ years of healthcare industry experience • 3+ years of experience with compliance and quality requirements related to healthcare and UM processes • Associate degree preferred; 2 or more additional years of experience may be considered instead • Analytical and 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 • Excellent verbal and written communication skills • Knowledge of legislative and oversight bodies, including NCQA, URAC, ERISA, and CMS preferred • Government-issued photo ID required for identity verification • Comprehensive background check required • In-person I-9 verification required • May be subject to drug screening prior to employment • High-speed internet over 10 Mbps at home • Ability to plug directly into the home internet router for call center employees • AI tools prohibited and monitored during interviews

🏖️ Avantages

• Work/life balance • Flexible work arrangements • Autonomy in getting work done • Health insurance benefits for qualifying employees

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