Claims Examiner

NTT DATA•Plano, TX

47d•Remote

About The Position

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 -
Toggling back and forth between screens/can you navigate multiple systems.
Working knowledge of MS office products - Outlook, MS Word and MS-Excel.

Nice To Haves

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

Responsibilities

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