Correspondence Policy Specialist

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.

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.
• Research state regulatory requirements for clinical correspondence and policies using online technology and research tools.
• Consults with IT to support the letter generation process.

Requirements

• Degree preferred or 5+ years of equivalent healthcare industry experience.
• 3+ years of healthcare industry experience.
• 3+ years of experience with compliance and quality requirements related to healthcare and UM processes.
• Analytical/problem solving skills.
• Strong interpersonal, consultation, organizational, tracking and follow-up skills.
• Ability to research, obtain, coordinate, and integrate direction and feedback from diverse operational groups and organizations into a written product.
• Excellent verbal and written communication skills.
• Knowledge of legislative/oversight bodies (e.g., URAC, ERISA, CMS).

Benefits

• Comprehensive health insurance benefits.
• Bonus component dependent on pre-defined performance factors.