The Supervisor, Clinical Correspondence is responsible for hands-on support and oversight of the clinical correspondence staff. The supervisor will review correspondence and guide staff that compose, edit, and review written medical management determination letters across all Healthfirst managed care products. They will ensure that a wide variety of organizational determination letters to enrollees, providers and facilities including initial determination, fair hearing and detailed letters of denial across all product lines are clear, succinct and meet all NY State and/or CMS notice requirements. (This includes timeliness of notices and content). Will work in collaboration with care managers, the management team and peer reviewers to comply with regulatory-mandated notices. They will analyze/audit letters for appropriate medical terminology and use complying with organizational policies, as well as federal and state regulations governing organizational determinations. This will ensure corporate compliance with member, and provider written notices and reduce organizational risk for sanctions and non-conformance.

Job Profile Summary

The Team Lead (TL) Clinical Correspondence is responsible for hands-on support and oversight of the clinical correspondence team. The TL will review correspondence and guide staff that compose, edit, and review written medical management determination letters across all Healthfirst managed care products. They will ensure that a wide variety of organizational determination letters to enrollees, providers and facilities including initial determination, fair hearing and detailed letters of denial across all product lines are clear, succinct and meet all NY State and/or CMS notice requirements. (This includes timeliness of notices and content). Will work in collaboration with care managers, the management team and peer reviewers to comply with regulatory-mandated notices. They will analyze/audit letters for appropriate medical terminology and use complying with organizational policies, as well as federal and state regulations governing organizational determinations. This will ensure corporate compliance with member, and provider written notices and reduce organizational risk for sanctions and non-conformance.

Duties/Responsibilities:

• Active involvement and leadership of the clinical correspondence team's day-to-day operations; ensuring that staff is consistent with Healthfirst’s policies and procedures; and are in compliance with contractual, state and federal guidelines
• Supervises, analyzes and coordinates the unit's daily activities to ensure that departmental productivity goals are met with regards to quality, timeliness, accuracy and consistency of written communications
• Anticipates daily workload and explores opportunities for improved efficiencies without compromising quality of correspondence
• Collects data and analyzes trends in adverse determinations and timeliness of decision-making and notices.
• Communicates to management teams outcomes of analysis and collaboratively assists in development of improvement strategies for compliance with regulations
• Develops and monitors goals for employees, provides ongoing feedback and coaching.
• Ensures an atmosphere within the team that fosters open communication, teamwork, ownership and empowerment to make decisions
• Conducts performance reviews on an annual basis; coaches for performance; leads by example
• Participates in special projects initiated by the Manager.
• Assists Manager in coordinating regulatory, quality and accreditation activities
• Additional duties as assigned

Minimum Qualifications:

• High School Diploma or GED
• Work experience in a managed care environment
• Working experience in a fast-paced environment overseeing multiple tasks and supporting multiple team members
• Excellent written and verbal communication skills
• Flexibility to accommodate changes driven by contract requirements, benefit changes, and external drivers to process changes

Preferred Qualifications:

• Bachelors degree from an accredited institution
• Knowledge of CMS Chapter 13 and NY State PHL Article 44 & 49
• Leadership experience in managing, coaching, and developing employees.
• Critical/Creative Thinking and Problem-solving skills
• Adept at Planning, Organizing and Executing
• Strong technical skills to support clinical correspondence processing

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480

• All Other Locations (within approved locations): $71,594 - $106,080

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.