Member Notification Monitoring Specialist

Summary

The Member Notification Monitoring Specialist will report directly to the UM Supervisor & Manager under the guidance of the VP of Medical Affairs. Their primary role is to implement Health Plan (HP) letter templates, direct the implementation process from beginning to end and preform quality assurance checks.

Duties and Responsibilities

• Maintain HP Letter templates updates received via email from Health Plans, DHCS, HICE or other entities
• Maintain knowledge of HP letter standards & regulations i.e. Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS), NCQA, etc. Contact the health plan if further information is needed or if there are questions that need answering.
• Collaborate and communicate HP letter template updates with Compliance and Health Information Technology (HIT) team members
  • Submit new/updated template request to HIT via internal software.
  • Assist Business Analyst (BA) with HP template testing environment for each line of business and language
  • Assist BA with HP template validation and quality assurance check
  • Assist UM Supervisor with review and sign off on HP letter template implementation
  • Help find and correct any post-production issues with template formatting for implementation with HIT
• Verify that all letter templates have:
  • The mandated languages for each of line of business
  • The appropriate/needed Non Discrimination Notices and language inserts.
  • The correct county
• Correct any style or formatting in order for this information to be pulled through internal software (appropriate font, bold, italics, etc.). Submit appropriate created tags for each letter.
• Weekly monitoring of implemented HP templates to ensure correct templates were used and format is correct.
• Regular attendance at UM/HIT workgroup meetings

Minimum Job Requirements

• High school diploma or GED equivalent
• Knowledge of medical terminology
• Knowledge of NCQA Standards, DMHC, DHCS, and CMS regulatory requirements
• Proficiency in Microsoft Office programs, especially Word and Excel

Preferred Job Requirements

• Master’s Degree – Preferably in Business Administration, Healthcare Administration, Finance, Accounting
• Hospital, IPA and/or MSO experience

Knowledge, Skills and Abilities Required:

• Strong organizational and task prioritization, self-directed and proactive
• Strong professional writing skills including proper grammar, punctuation and formatting
• Ability to multi-task while remaining adaptable and flexible to fast-paced environment
• Ability to keep up with constant changes and requests
• Preferred: understanding of tables, mail merges, and tag elements in Microsoft Word