NTT DATA
Medicare Appeals Clinical Leader
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 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.
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 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.