Delivery Senior Manager

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 :

Preferred Skills & Experiences :

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

Technical Performance and Issue Tracking

Remote Workspace

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