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Delivery Senior Manager

Delivery Senior Manager

NTT DATAPlano, TX, US
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Medicare Appeals Clinical Leader

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.

In This Role The Candidate Will Be Responsible For :

  • 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.

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

    • Preferred Skills & Experiences :

  • 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

    • 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.

    Remote Working and Technology Requirements

    To work remote, individuals must meet all the established Remote requirements including those pertaining to a home workspace and related technology.

    Technology

  • NTT DATA will provide a computer and headset for remote work.
  • Employees are responsible for the care and security of all equipment provided. They must return it immediately upon separation from the company following company protocols.
  • Failure to return equipment may result in collection actions and / or other consequences.
  • 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.

    • Technical Performance and Issue Tracking

  • Management monitors all technical issues and agent downtime. Consistent availability is critical to business operations.
  • Remote employees must adhere to all technical support procedures and protocols.
  • Chronic connectivity issues or recurring downtime that impede job performance, including internet outages, may result in the remote status changing to onsite.

    • Remote Workspace

    Remote work demands a high degree of professionalism, self-discipline, and accountability. The following workspace standards are vital to delivering exceptional service.

  • 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.
  • Ideally, the workspace is isolated from other household members and used exclusively for job duties.
  • Background noise, interruptions from people or pets, and other distractions must be kept to an absolute minimum to avoid disruptions to customer service.
  • Employees must work from the same location consistently unless prior approval is obtained.
  • If a change in work location is necessary :
  • The new location must meet all Remote Workspace and Technology Requirements.
  • Notification to NTT DATA Management is required before relocating.
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    Delivery Manager • Plano, TX, US