HC & Insurance Operations Processing Sr Rep

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/can you navigate multiple systems.

o             Working knowledge of MS office products – Outlook, MS Word and MS-Excel.

Preferred Skills & Experiences:

•             Amisys or Xcelys

•             Medicaid and Medicare Claims processing experience

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

•             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