Delivery Senior Manager

NTT DATA • Plano, TX

193d • $100,500 • Remote

About The Position

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.

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 up to 25%.

Nice To Haves

• 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.

Responsibilities

• 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.

Benefits

• 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.
• Additional voluntary or legally required benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Professional, Scientific, and Technical Services
• Education Level: Bachelor's degree