Delivery Senior Manager

NTT America-posted 2 months ago
Full-time • Senior
Remote • Plano, TX
5,001-10,000 employees
Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services
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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.

  • 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.
  • 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%.
  • 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.
  • 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.
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