HC & Insurance Operations Processing Sr Rep - Remote Eligible

Remote Claims Processing Associate

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 and institutional claims

• Reviewing the policies and benefits

• Complying with company regulations regarding HIPAA, confidentiality, and PHI

• Abiding with the timelines to complete compliance training of NTT Data/Client

• Working independently to research, review and act on the claims

• Prioritizing work and adjudicating claims as per turnaround time/SLAs

• Ensuring 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 calculating claims payable amount using applicable methodology/fee schedule

Requirements:

• 3 year(s) hands-on experience in Healthcare Claims Processing

• 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.

Preferred Skills & Experiences:

• Amisys or Xcelys

• Medicaid and Medicare Claims processing experience

• 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