Delivery Senior Manager

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 an