CareCentrix

Director - Healthcare Correspondence

US-FL-Tampa
Job ID
2017-4767
Category
Quality & Process Improvement

Overview

Directs and leads CareCentrix correspondence processes, implementation(s), and compliance; facilitates successful partner relationships. Implements process improvements, operational metrics, and quality monitoring for the processing of all correspondence requirements to meet contract, accrediting, and regulatory obligations. Works under limited direction.

Responsibilities

  • Responsible for all authorization letters, denial letters, claims, Explanation of Benefits (EOBs), etc., and billing correspondence.
  • Knows and stays current with regulations and requirements regarding correspondence. Proactively recommends changes in systems and processes in order to maintain compliance.
  • Develops ‘early warning’ tools and proactively monitors reports, systems, operational metrics, and processes to identify errors or problems.
  • Continuously monitors system and process for improvement opportunities.
  • Conducts scheduled and ad hoc audits to assure correspondence content, timeliness, and process is in line with requirements.
  • Works with Operations to implement process improvements, changes, and fixes in response to new requirements, errors or problems, and opportunities for improvement.
  • Works with IT to implement system improvements, changes, and fixes in response to new requirements, errors or problems, and opportunities for improvement.
  • Liaison between CCX and internal customers (compliance, claims, etc.) and external correspondence vendor(s). 
  • Monitors vendor performance proactively through operational metrics and via reports to assure compliance with all requirements.
  • Develops, implements, and oversees a returned mail policy and procedure.
  • Reviews and adheres to all Company policies and procedures and the Employee Handbook.
  • Participates in special projects and performs other duties as assigned. 

 

Qualifications

  • Bachelor’s Degree in a related field or the equivalent plus a minimum of 7 years of experience in managed care or healthcare compliance field(s). 
  • Understanding of IT systems and automation required; project management or process improvement experience strongly preferred.
  • Knowledge of Utilization Management functions, Center for Medicare and Medicaid Services (CMS), Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) Standards, State and Federal Requirements and Regulations, and all client contractual requirements.
  • Expertise in Microsoft Office.

 

 

CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.

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