Correspondence Policy Specialist

Evolent

1d • $25 - $27

About The Position

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. Our shared services team offers candidates the opportunity to make a meaningful impact by providing exceptional support to internal and external customers through positive interactions, and timely delivery of high-quality products. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes. A Correspondence Policy Specialist on the Shared Services Correspondence team will be working with a highly skilled team of specialists responsible for the development, approval, and maintenance of corporate clinical correspondence. Together, the team ensures compliance with legislative and accreditation requirements, adheres to procedures, designated roles and responsibilities as outlined in the corporate correspondence policy.

Requirements

• 3+ years of healthcare industry experience. - Required
• 3+ years of experience with compliance and quality requirements related to healthcare and UM processes. - Required
• Associates preferred but consideration for 2 or more additional years of experience will be considered.
• Analytical/problem solving skills - Required
• Strong interpersonal, consultation, organizational, tracking and follow-up skills. - Required
• Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product. - Required
• Possesses excellent verbal and written communication skills - Required
• Knowledge of legislative/oversight bodies [e.g., National Committee for Quality Assurance Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974 (ERISA), Centers for Medicare and Medicaid Services (CMS) - Required
• To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID.
• We conduct identity verification during interviews, and final interviews may require onsite attendance.
• All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment.
• The use of artificial intelligence tools during interviews is prohibited and monitored.
• Misrepresentation will result in immediate disqualification from consideration.
• We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.

Responsibilities

• Develops and customizes correspondence according to regulatory requirements and contractual requirements including coordinating Compliance Department approval for new and existing business.
• Provides oversight of the use of appropriate correspondence and review requests for new or modifications to existing correspondence templates.
• 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 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 segments.
• 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.

Benefits

• As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree