HC & Insurance Operations Senior Assoc. at NTT DATA

Chennai, tamil nadu, India -

Full Time

Start Date

Immediate

Expiry Date

12 Mar, 26

Salary

0.0

Posted On

12 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider Data Management, Provider Data Validation, Training, Quality Assurance, Process SOP, Process Mapping, Discrepancy Reporting, Automation, Claims Management, End to End Provider Billing, EDI Rejection Handling, Demographic Changes, Logical Thinking, Communication Skills, MS Office, Client Interaction

Industry

IT Services and IT Consulting

Description

PROVIDER DATA MANAGEMENT - GRADE 5 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. 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. 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

Responsibilities

The analyst will process and review Provider Data Management and Enrollment Resources, ensuring compliance with policies and procedures. They will also lead teams in managing day-to-day inventory and monitor quality assurance scores to improve performance.