DENTAQUEST LLC Operations Document Specialist III in MILWAUKEE, Wisconsin

JOB REQUIREMENTS: 3049-703 Identify changes to State and/or Federal regulations, MCO contracts or NCQA requirements that may affect content of letters generated from Utilization Management and Complaints and Grievances activity. Participate in Market Meetings to understand Client requirements and communicate any items that will impact determination or appeal letters. Maintain tracking mechanism for current and historical templates for each client. Tracking mechanism is to include client approval and version of template that was approved. Perform periodic audit of templates in production to ensure most recent approved version is being used. Coordinate with Client Services and/or Correspondence System to make any necessary changes. Coordinate template implementation with Client, Client Services, Correspondence System and Denial Letters groups. This process to include: Mock-up of template and submission to Correspondence System group Review of template sample to ensure accurate Coordinate with Client and/or Correspondence System group revisions needed based on review of sample Obtain approval for template Coordinate with Correspondence System group to move approved template to production Communicate template additions or changes to Denial Letters group Perform duties of Operations Document Specialist I, as necessary Perform duties of Operations Document Specialist II, as necessary Other administrative duties as assigned. 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: 1-3 years experience in related setting. Previous experience with denial letter templates preferred. Knowledge of Centers for Medicare & Medicaid Services (CMS) guidelines for Medicare and Medicaid, National Committee for Quality Assurance (NCQA), State Medicaid regulations or compliance requirements. Ability to prioritize and organize multiple tasks. Ability to work independently. Good PC Skills. Excellent analytical ability. Strong attention to detail. Typing skills of 60+ wpm. Excellent verbal and written communication skills. Ability to remain organized with multiple interruptions. Strong knowledge of Word and Adobe PDF Writer programs. ***** APPLICATION INSTRUCTIONS: Apply Online: