DENTAQUEST LLC Operations Correspondence Analyst in MILWAUKEE, Wisconsin

JOB REQUIREMENTS: Tracking Code 3153-703 Job Description The Operations Correspondence Analyst is part of the Operations Compliance team, reporting to the Operations Correspondence & Support Supervisor. The role is responsible for implementation and maintenance of 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 forutilization 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 regulatoryrequirements. Presentation of the CRD content to the client. Coordinate revisions necessary to final completion and clientapproval. Identify the templates required for implementation, based on operational process and requirements. Draft atemplate 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 anddevelop strategic solutions to ensure compliance with requirements. Coordinate template implementation and revisions with the client, client services, operations, thecorrespondence technical team and the Operations Correspondence & Support Supervisor. Define the rules necessary to accurately populate variable information within the template. Communicatethe rules effectively to the correspondence technical team. Mock up samples of the templates and submit to the correspondence technical team to draft productionsamples. Define the parameters to be utilized to produce the samples, when necessary. Review productionsamples provided to ensure accuracy. Obtain approval from the client of the production samples. Coordinate through client services, asnecessary. Coordinate production of the template with the correspondence technical team after approval has beenreceived. Coordinate with the Operations Correspondence & Support Supervisor to create cases to test triggers fortemplates 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 findingsidentified 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. DentaQuest is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, sex, age, disability, marital status, or sexual orientation. ***** OTHER EXPERIENCE AND QUALIFICATIONS: 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 re ulatory 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. Minimum 3 years' experience in a healthcare related field ***** APPLICATION INSTRUCTIONS: Apply Online: