Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.Job Posting TitleEnrollment Correspondence Policy SpecialistJob Description SummaryResponsible for the development, approval and maintenance of corporate clinical correspondence to ensure compliance with legislative and accreditation requirements. Adheres to procedures, designated roles and responsibilities as outlined in the corporate correspondence policy.Job DescriptionEssential Functions
Provides oversight of the use of appropriate correspondence and review requests for new or modifications to existing correspondence templates.
Develops and customizes correspondence according to regulatory requirements and contractual requirements including coordinating Compliance Department approval for new and existing business
Oversees clinical correspondence for all products in collaboration with Compliance
Updates clinical correspondence templates as needed to ensure they meet the minimum standards for National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS), and Company Policy across product lines and business segment
Tasked with problem solving and negotiation with internal and external customers around complex concepts and competing interests for risk mitigation and avoidance of Corrective Action Plans
Researches state regulatory requirements for clinical correspondence and policies using online technology and research tools
Consults with IT to support the letter generation process
Minimum Required Qualifications
2 years healthcare industry experience
2 years operations experience
Additional Qualifications
Analytical/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
Possesses excellent verbal and written communication skills
Knowledge of legislative/oversight bodies
System configuration
Proficiency in Microsoft Word, Excel and PowerPoint
Education
Bachelor's degree or equivalent combination of education and/or relevant work experience; HS Diploma/GED is required.
ResponsibilitiesWork ExperienceWork Experience - Required:Work Experience - Preferred:EducationEducation - Required:Education - Preferred:BachelorsCertificationsCertifications - Required:Certifications - Preferred:Potential pay for this position ranges from $20.76 - $31.14 based on experience and skills. Pay range may vary by 8% depending on applicant location.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.Prime Therapeutics LLC is an Equal Opportunity Employer and a Tobacco-free workplace . We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures .Positions will be posted for a minimum of five consecutive workdays.Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [email protected].