PROVIDER DATA MANAGEMENT - GRADE 5

HC & Insurance Operations Senior Assoc.

Position Overview:

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.

NTT DATA Services currently seeks a HC & Insurance Operations Senior Assoc. to join our team in CHENNAI

Position General Duties:.

Analyst will process and review Provider Data Management and Provider Data Enrollment Resources to the Client main application according to its policies and procedures defined.

Role Responsibilities:

In-depth knowledge and experience in the US healthcare (Non Voice) – Provider Data Validation and Provider Data management.
Ability to train the team on new process and process updates.
Calibrate with QA's to ensure process knowledge and variance are managed and under control.
Ability to create Process SOP, Process Map and identifying the outlier within process.
Review Discrepancy report and comments, identify gaps and share with TL.
Identify NVA and provide suggestion for automation opportunities.
Leads teams to manage day to day inventory
Monitors QA scores of production resources and performs reviews to improve overall performance
Floor support to operations and 1st point of level of escalation to client in process, inventory, and performance metrics
Identify refresher/re-trainable topics, conduct assessments, and certify staff to move to different levels of production.
Drive team from the front in case of leadership unavailability.
Need to co-ordinate with quality team to identify the root cause and provide appropriate solution to overcome errors.
Ensures day-day transactions are processed per standard operating procedures.
Follows Work process flow to ensure pends are completed and maintain Quality and timeliness standards.
Knowledge in Amisys and Cenprov application are preferred.
Product knowledge in checking affiliation for Medicaid, Medicare and Exchange.
Everyday checked Contract information in Payment Index such as, Pay class, override key, accepts code and etc.
Ability to read and understand the provider contract.
Handling Paid claims and recouped claims.
Claims Rejections handling.
Working in claims denial management.
Knowledge about End to End provider billing process.
Working knowledge in EDI rejection claims
Handing Patient and provider demographic changes.

Required Skills:

3+ years of experience in US healthcare working with Provider Data Management.
Ability to work regularly scheduled shifts from Monday-Friday 20:30pm to 5:30am IST.
University degree or equivalent that required 3+ years of formal studies.
Ability to work in a team environment.
Good logical thinking ability.
Good English Comprehension/written skills should have exposure to MS Office.
Good Communication Skills – Both Verbal and Written
Ability to interact with clients preferred.
Own Transport
Required schedule availability for this position is Monday-Friday 6PM/4AM IST The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.