Delivery Senior Manager

NTT DATA•Plano, TX

51d•Remote

About The Position

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a Delivery Senior Manager to join our team. 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. This position is eligible for company benefits including 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, and additional voluntary or legally required benefits. Pay for this role is $100,500.00 Salary

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 upto 25%.
New hires must have a working device (such as cell phone or tablet) for the 2-Factor Authentication process.
Must Pass Drug screen.
Must Pass a background check with Education check and employment verification check.
To work remote, individuals must meet all the established Remote requirements including those pertaining to a home workspace and related technology.
Individuals must provide their own high speed internet access with speeds at or above 50 Mbps.
A hard-wired ethernet connection is required. Wi-Fi, mobile, wireless and public internet connections are forbidden as are connections outside of one's personal dwelling or location.
Remote employees must adhere to all technical support procedures and protocols.
Employees must have a dedicated, professional workspace conducive to servicing Customer Service customers with the same quality as an onsite environment.
The workspace must be a permanent, unencumbered location used daily for work.
Employees must work with minimal distractions that do not interfere with business operations or service delivery.
Employees must work from the same location consistently unless prior approval is obtained.
The new location must meet all Remote Workspace and Technology Requirements.
Notification to NTT DATA Management is required before relocating

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.