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Compliance and Policy/Process Review Research and review federal and state regulations to determine the applicability to operations. Coordinate with Legal and Compliance, as necessary. Assist with the development of policies and procedures for operations, as well as the annual policy review. Work collaboratively with a technical writer to draft and review of RFP responses on behalf of operations,
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Manage efforts to implement and revise correspondence, resulting from operation activity forutilization management, claims, and complaints/grievance/appeals, to ensure accurate content within the templates and the templates are implemented or revised within the timelines required. Completion of the client requirement document (CRD) to accurately reflect contract and regulatoryrequirements. Present
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Perform testing on an agile team Work with the development team to create test plans and test cases Review all documentation provided by the project teams and ensure full understanding of the documented requirements, technical enhancements, process development and workflow configuration required Develop and execute test scripts using manual and automated testing as specified by DQ standards Docume
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Manage efforts relating external audits for complaints/grievances/appeal to carry forth quality audit documentation in a timely fashion. This to include Completion of audit tools provided by the auditing entity Compile audit universe, based on instruction received from the auditing entity Complete data validation of the audit universe content Conduct WebEx demonstrations to the auditing entity of
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Takes end to end hands on ownership and command of the proposal process. Creates project charters and work plans to lead kick off and launch of RFP responses Identify and engage with critical subject matter experts and decisions makers. Analyzes government solicitations, identifies response requirements, and prepares new, customized, and detailed proposal response outlines, templates to ensure ful
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Maintain provider data in vision systems and build constructive working relationships with key individuals at provider offices Set up and maintain accurate and clean provider information in all vision systems. Ensure all data necessary to generate provider payments and reports is captured and accurate in vision systems. Ensure placement of all members for all services administered for vision progr
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Develop project plans and associated communication documents to manage accreditation activities and ensure deliverable are completed in alignment with all requirements, timelines and quality expectations. Completes and presents reports utilizing principles of qualitative and quantitative analysis to evaluate standards, measure effectiveness and identify opportunities for improvement. Coordinates a
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Lead small to large scale team engagements that include multiple deliverables. Act as key contact with clients to ensure client needs are met; ensure timeline and deliverables stay on target. Become valued partner to clients, and ensure client and team keep goals top of mind. Develop and manage strategy sessions, such as brainstorming sessions, with client and team members to identify actionable b
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Assess current processes, identify defects, areas of improvement and to be process design. Lead projects by developing effective project plans and managing resources to meet business expectations. Lead departmental process improvement initiatives. Facilitate process changes across departmental functions. Research, analyze, select applicable tools, systems to automate or facilitate process improvem
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The Director, reporting to the Vice President, Chief Ethics and Compliance Officer, will provide a broad range of compliance services in support of the overall enterprise and will lead compliance initiatives as well as lead and manage a team of compliance professionals dedicated to achieving compliance through the organization and within their respective business division. PRIMARY JOB RESPONSIBILI
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Oversee enrollment and credentialing of Providers in accordance with requirements (NCQA, CMS, etc.). Ensure DentaQuest's credentialing process meets client expectations and state regulations. Assist with delegated credentialing audits as needed. Ensure all Applications and Site Reviews are tracked. Ensure reports are prepared accurately, timely and work to automate the reports where applicable. Al
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Intake new contracts and amendments to analyze and assign provisions to appropriate departments for review and response Conduct end to end audits of Client Contracts to ensure compliance with provisions contained within Prepare and manage action items resulting from a compliance audit Assist in preparing responses to Client Corrective Action Plans and in assuring compliance of action items resulti
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Serve as a catalyst by facilitating internal connections, translating social impact and business goals into actionable next steps, and creating and sharing content that supports long term integration of the different divisions of DentaQuest. Leveraging expert interpersonal skills and strong writing abilities, the person in this roll will Break down and close the knowledge gap between the areas of
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Electronically review assigned faxes and emails daily. Receive assigned mail relating to provider enrollment daily and turn electronic. Process assigned provider enrollment documents daily. Re direct non credentialing documents daily. Stamp all enrollment documents assigned daily. Conduct review of assigned provider enrollment documents daily. Research for active records in enterprise system. Ente
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Interns will be required to assist in various departments handling multiple projects by allotted time frames JOB DUTIES AND RESPONSIBILITIES Design and communication skills, and the ability to work as an individual or collaboratively Consistently meet project specific deadlines and project goals of assigned department. Consistently seek out and utilize appropriate department resources to complete
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