Job Description

Req ID:  318029  

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.

We are currently seeking a Delivery Senior Manager to join our team.

NTT DATA is seeking to hire a Medicare Appeals Clinical Leader to lead service delivery engagements and improve end-to-end delivery of Medicare Appeals. Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end delivery of services.

This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, flexible spending or health savings account, life and AD&D insurance, short- and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.

Pay for this role is $100,500.00 Salary

In this Role the candidate will be responsible for:

• Develop and implement strategies to improve workstream efficiency and quality. 
• Collaborate with internal and external leadership on overall service delivery design and requirements for successful performance
• Stay updated on Medicare appeals regulations and guidelines from CMS collaborating with customers that all appeals are handled in accordance with federal and state laws. 
• Identify potential compliance risks and implement corrective actions
• Collaborate with health plans, clinical teams, utilization management, and other departments to address complex cases and identify trends. 
• Establish communication plans with various levels of customer organizations regarding performance, metrics, and processes. 
• Track appeal metrics, including case volumes, resolution times, and denial rates. 
• Analyze processes to identify and recommend improvements, especially related to clarity of written recommendations and interpretations of records. 
• Prepare reports for senior management on appeal trends and compliance status. 

Requirements:

• Requires Bachelor’s degree
• 8 years of health plan appeals experience, specifically in clinical appeals
• Deep understanding of Medicare policies, coverage guidelines, and appeals process

• Strong clinical knowledge and ability to interpret medical records, documenting recommendations to uphold or overturn denials
• Excellent analytical and problem-solving skills
• Strong communication and presentation to interact with diverse stakeholders at various organization levels
• Leadership experience in managing a team and achieving results
• Experience with healthcare regulations and compliance requirements
• Ready to Travel upto 25%.

Preferred Skills & Experiences:

• Presentation and communication experience, creating decks to convey topics including status, value, processes
• Advanced organizing and planning skills to oversee project deliverables.
• Advanced priority setting and delegation skills.
• Advanced analytical, problem solving, negotiation and communication skills

New hires must have a working device (such as cell phone or tablet) for the 2-Factor Authentication process.

Must Pass Drug screen.

Must Pass a background check with Education check and employment verification check. 

Remote Working and Technology Requirements

To work remote, individuals must meet all the established Remote requirements including those pertaining to a home workspace and related technology.

Technology

• NTT DATA will provide a computer and headset for remote work.
• Employees are responsible for the care and security of all equipment provided. They must return it immediately upon separation from the company following company protocols.
• Failure to return equipment may result in collection actions and/or other consequences.
• Individuals must provide their own high speed internet access with speeds at or above 50 Mbps.
• A hard-wired ethernet connection is required. Wi-Fi, mobile, wireless and public internet connections are forbidden as are connections outside of one’s personal dwelling or location.

Technical Performance and Issue Tracking

• Management monitors all technical issues and agent downtime. Consistent availability is critical to business operations.
• Remote employees must adhere to all technical support procedures and protocols.
• Chronic connectivity issues or recurring downtime that impede job performance, including internet outages, may result in the remote status changing to onsite.

Remote Workspace

Remote work demands a high degree of professionalism, self-discipline, and accountability. The following workspace standards are vital to delivering exceptional service.

• Employees must have a  dedicated, professional workspace conducive to servicing Customer Service customers with the same quality as an onsite environment.
• The workspace must be a  permanent, unencumbered location used daily for work.
• Employees must work with  minimal distractions that do not interfere with business operations or service delivery.
• Ideally, the workspace is  isolated from other household members and used exclusively for job duties.
• Background noise, interruptions from people or pets, and other distractions must be kept to an absolute minimum to avoid disruptions to customer service.
• Employees must work from the  same location consistently unless prior approval is obtained.
• If a change in work location is necessary:
• The new location must meet all  Remote Workspace and Technology Requirements .
• Notification to NTT DATA Management is required before relocating

#INDBPO

#LI-MIWS

About NTT DATA

NTT DATA is a $30 billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize and transform for long term success. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure and connectivity. We are one of the leading providers of digital and AI infrastructure in the world. NTT DATA is a part of NTT Group, which invests over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. Visit us at  us.nttdata.com

NTT DATA endeavors to make accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at .  This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here . If you'd like more information on your EEO rights under the law, please click here . For Pay Transparency information, please click here .

Job Tags

Similar Jobs