NTT DATA is seeking a Healthcare Operations Processing Senior Representative to join our team. In this fully remote role, you will process professional healthcare claims for a client, ensuring accurate adjudication, strict compliance with regulations, and maintenance of high-quality standards.
What You'll Do
- Process professional claim forms files submitted by providers.
- Review policies and benefits to determine coverage and eligibility.
- Ensure compliance with company regulations regarding HIPAA, confidentiality, and PHI.
- Complete all required compliance training for NTT DATA and the client in a timely manner.
- Work independently to research, review, and act on claims.
- Prioritize work and adjudicate claims according to defined turnaround times and SLAs.
- Follow client-defined workflows and guidelines for all claims adjudication.
- Sustain and meet client productivity and quality targets to avoid penalties.
- Maintain quality scores above 98.5% for PA and 99.75% for FA.
- Respond to and resolve claims received via email promptly as priority work.
- Correctly calculate claims payable amounts using applicable methodology and fee schedules.
What We're Looking For
- 3+ years of hands-on experience in Healthcare Claims Processing.
- 2+ years of experience using a computer with Windows applications, navigating multiple screens and systems, and learning new software.
- A high school diploma or GED.
- Proven experience performing in a production and quality (P&Q) work environment, working from a queue, and working remotely.
- Strong keyboard proficiency and computer familiarity, including toggling between multiple screens and systems.
- Working knowledge of MS Office products (Outlook, Word, Excel).
Nice to Have
- Experience with the Amisys system.
- Ability to communicate effectively, both orally and in writing, in a professional office setting.
- Effective troubleshooting skills using research, analysis, and problem-solving abilities.
- Strong time management skills with the ability to cope in a complex, changing environment.
Technical Stack
- Windows applications
- MS Office (Outlook, Word, Excel)
- Amisys
Work Mode
This is a fully remote position.
NTT DATA is an equal opportunity employer.
