Medical Records & Appeals Specialist

NTT DATA, Inc.; Metro Manila; Sur place; PHP 300 000 - 600 000; Plein temps

Avantages offerts par ce poste

RN benefits

Résumé du poste

NTT DATA, Inc. in Manila, Philippines is seeking a BPO Medical Records Specialist to support Medicaid and NCQA compliant appeals processing.

The role involves researching appeals, preparing case reviews, and communicating with providers and facilities to ensure timely, accurate decisions. The ideal candidate will have 1–3 years in appeals or utilization management, RN licensure, and strong analytical and written communication skills.

Qualifications

• 1–3 years of appeals or utilization management experience.
• RN - Registered Nurse with state licensure.
• Knowledge of utilization management, NCQA, Medicaid regulations.
• Strong reading and writing communication skills; ability to work independently.

Responsabilités

• Research appeals for Medical Directors by reviewing criteria and basis for appeal.
• Prepare case reviews and ensure timely processing per standards.
• Communicate with providers and facilities regarding requests for appeals.
• Generate appeal resolution communications and reports for members and providers.
• Collaborate with leadership to improve the consistency and efficiency of responses to all appeal requests.
• Maintain files on individual appeals with documentation of verbal and written member and provider appeals.

Connaissances

RN license

Communication

Analytical

Independent worker

Formation

RN - State licensure

Description du poste

NTT DATA, Inc. in Manila, Philippines is seeking a BPO Medical Records Specialist to support Medicaid and NCQA compliant appeals processing.

The role involves researching appeals, preparing case reviews, and communicating with providers and facilities to ensure timely, accurate decisions. The ideal candidate will have 1–3 years in appeals or utilization management, RN licensure, and strong analytical and written communication skills.