HC & Insurance Operations Processing Sr Rep

NTT DATA Services•Plano, TX

3d•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 claim forms files by provider, reviewing policies and benefits, and complying with company regulations regarding HIPAA, confidentiality, and PHI. The candidate will also need to abide with the timelines to complete compliance training of NTT Data/Client, work independently to research, review and act on the claims, and prioritize work and adjudicate claims as per turnaround time/SLAs. Ensuring claims are adjudicated as per clients defined workflows and guidelines, sustaining and meeting the client productivity/quality targets to avoid penalties, and maintaining and sustaining quality scores above 98.5% PA and 99.75% FA are also key responsibilities. Additionally, timely response and resolution of claims received via emails as priority work and correctly calculating claims payable amount using applicable methodology/ fee schedule are expected.

Requirements

3 year(s) hands-on experience in Healthcare Claims Processing
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
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
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 claim forms files by provider
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