HC & Insurance Operations Processing Sr Rep

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company’s growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.

 

For more than 25 years, NTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.

 

NTT DATA currently seeks a Medical Claims Processor to join our team in Plano, TX for a remote position.

 

This is a US based; W-2 project. All candidates will be paid through NTT DATA only.

 

Role Responsibilities

-Processing of Professional claim forms files by provider

-Reviewing the policies and benefits

-Comply with company regulations regarding HIPAA, confidentiality, and PHI

-Abide with the timelines to complete compliance training of NTT Data/Client

-Work independently to research, review, and act on the claims

-Prioritize work and adjudicate claims as per turnaround time/SLAs

-Ensure claims are adjudicated as per clients defined workflows, guidelines

-Sustaining and meeting the client productivity/quality targets to avoid penalties

-Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.

-Timely response and resolution of claims received via emails as priority work

-Correctly calculate claims payable amount using applicable methodology/ fee schedule

-Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities

-Time management with the ability to cope in a complex, changing environment

-Ability to communicate (oral/written) effectively in a professional office setting

 

Required Skills/Experience  

• 1+ year(s) hands-on experience in Healthcare Claims Processing
• Previously performing – in P&Q work environment; work from queue; remotely
• 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
• Key board skills and computer familiarity –
• Toggling back and forth between screens/can you navigate multiple systems.
• Working knowledge of MS office products – Outlook, MS Word and MS-Excel.
• Typing and Computer skills assessment

 

Preferences

Amisys &/or Xcelys Preferred

 

"NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team. 
In this Role the candidate will be responsible for:
•    Processing of Professional and institutional claims
•    Reviewing the policies and benefits
•    Comply with company regulations regarding HIPAA, confidentiality, and PHI
•    Abide with the timelines to complete compliance training of NTT Data/Client
•    Work independently to research, review and act on the claims
•    Prioritize work and adjudicate claims as per turnaround time/SLAs
•    Ensure claims are adjudicated as per clients defined workflows, guidelines
•    Sustaining and meeting the client productivity/quality targets to avoid penalties
•    Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.
•    Timely response and resolution of claims received via emails as priority work
•    Correctly calculate claims payable amount using applicable methodology/ fee schedule

Requirements:
•    3 year(s) hands-on experience in Healthcare Claims Processing
•    High school diploma or GED.
•    Previously performing – in P&Q work environment; work from queue; remotely
•    Key board skills and computer familiarity –
o    Toggling back and forth between screens/