Associate Operations Correspondence Analyst - DentaQuest

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Job Description:

JOB SUMMARY:

The Operations Correspondence Analyst is part of the Operations Compliance team, reporting to the Operations Correspondence & Support Supervisor. Implements and maintains 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 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 & Support Supervisor.
• 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 & Support Supervisor 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 & Support Supervisor 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 DentaQuest policies and proce