Medical Claims Examiner Remote

NTT DATA Services•Plano, TX

2d•Remote

About The Position

NTT Data is hiring a Medical Claims Examiner for a remote position. This role involves processing professional claim forms, reviewing policies and benefits, and ensuring compliance with HIPAA, confidentiality, and PHI regulations. The examiner will also adhere to company timelines for compliance training and work independently to research, review, and act on claims. Key responsibilities include prioritizing work, adjudicating claims within turnaround times/SLAs, ensuring adherence to client workflows and guidelines, and meeting client productivity/quality targets to avoid penalties. Maintaining high quality scores (above 98.5% PA and 99.75% FA) is crucial. The role also requires timely response and resolution of claims received via email and accurate calculation of claim payable amounts using applicable methodologies and fee schedules.

Requirements

1-3 year(s) hands-on experience in Healthcare Claims Processing, Claims Adjustments.
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.
Must be able to work 8 am - 4:30 pm EST online/remote (training is required on-camera).
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
Ability to communicate (oral/written) effectively in a professional office setting
High School Diploma

Nice To Haves

Amisys or Xcelys preferred.

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