Vision Contract Compliance Associate, Dentaquest

3 weeks ago

Wellesley Hills, United States DentaQuest Full time

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.
- DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all._

**Location**: We support US flexible working arrangements in the contiguous 48 states.

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.

**The opportunity**:
The Vison Contract Compliance Associate is responsible for contract deliverables, including audits, provider contracts, fee schedules, IOD’s and new/existing business benefit/program changes. This role handles internal review on an ongoing basis of vision systems and processes to ensure regulatory, client, and program quality standards are being met. The Vision Contract Compliance Associate will provide action plans and updates as needed based on findings.

**How you will contribute**:

- Primary point of contact within the vision department for Audits as it relates to coordination of documentation requests, completing audit tools, pulling universes, and responding to follow-up requests as it pertains to audits of the programs for Claims, UM, Correspondence and Network. Materials will be delivered accurately and within a timely fashion. Provide updates to Management on status of Audits
- Present information in person (or as required) to client for audits and answers questions regarding program(s) and information provided.
- Primary point of contact for new/existing business and program/benefit change implementations as it relates to Claims, UM, Correspondence, and Network
- Provide assists to Vision Leadership by managing current Vision programs and through implementation of new Vision programs related to, UM, Network, Claims, Correspondence, and Reporting. Provide weekly updates to management on the status of implementations
- Develops and submits IOD’s based on CMS, market, or client specific program requirements
- Handles replying to client CAPs for vision and ensuring all CAP deliverables are coordinated and delivered in a timely manner
- Identify areas of improvement in existing new implementation and audit related processes, operating mechanisms and methodologies. Work across the department to implement improvements.
- Develops tracking documents to coordinate follow ups of inter-departmental projects for vision team.
- Handle external client relationship calls, communication, project tracking and management/internal updates including relationships with systems partner, lab partner and other client project(s) as needed for programs.
- Coordinate implementation of new outbound client communication including letters, NOAs, and other program communications to ensure compliance with contractual approvals as necessary.
- Develop process for and monitor, outgoing communications and ensure continual compliance with contractual/program requirements. Review policies and procedures for ongoing compliance and manage projects for necessary updates identified internally or through client/external changes or review.
- Ensure changes needed due to audit deficiencies are implemented into production.
- Leads new business implementation projects that impact Vision.
- Lead new business and program change implementations including coordinating meetings, documentation, internal updates to CRDs or other documents, follow ups, communication and status updates for management and clients.
- Conduct Inter-rater reliability test for determinations made by prior-authorization processors.
- Coordinate and conduct general departmental training for new vision hires.
- Other duties as needed or required.

**What you will bring with you**:

- High School diploma or equivalent.
- 5 years’ experience within the healthcare field.
- Well-organized and exceptional organizational, written and oral communication skills, particularly presentation skills.
- Ability to work alone and as part of a team.
- Proficient with gener

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