Job Information
Healthfirst Clinical Correspondence/Writer-1 in Remote, New York
Duties and Responsibilities:
Conduct daily reviews of member and provider correspondence while reviewing clinical system (TruCare) events to ensure compliance with all State and Federal regulations.
Meet established time frames for completion of assigned correspondence.
Identify deficiencies and provide feedback to reduce errors and improve processes and performance to ensure quality.
Review and investigate a variety of member and provider correspondence to ensure all elements of the letter match what is in the Clinical system (TruCare) and ensure the correct template is being used appropriately.
Collaborate with care managers in UM, CM, the leadership team and peer reviewers to comply with regulatory-mandated notices.
Analyze/audit letters for appropriate medical terminology using departmental policies and federal and state regulations.
Assist with the creation, storage, protection, retrieval, and retirement of letters to enrollees, providers and facilities from company systems.
Ensure compliance with Healthfirsts corporate branding requirements.
Additional duties as assigned.
Minimum Qualifications:
HS diploma or GED
Excellent written and verbal communication skills
Ability to work efficiently
Critical/creative thinking and problem-solving skills.
Work experience in healthcare
Preferred Qualifications:
Article 44 and 49 of the NY State Public Health Law and Appendix F, Medicare Managed Care Manual Chapter 13 and/or commercial contracts and others as necessary.
Associates degree in related allied health care field.
Basic knowledge MS SharePoint preferred.
Regularly uses moderately complex oral and written skills. May train others in functional areas and interact with others across Healthfirst and/or externally.
Demonstrated flexibility to accommodate changes; approachable,neutral and objective approach.
Experience with Utilization Management, government programs and managed care, including but not limited to, processing organizational determinations- approvals and denials, or appeals and grievance type of events.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.