RN Medical Records & Appeals Specialist

NTT DATA, Inc.; Manila; Hybrid; PHP 360,000 - 540,000; Full time

Job summary

NTT DATA, Inc. in Manila, Quezon (PH-QUE), Philippines seeks a BPO Medical Records Specialist to support case reviews, medical directors, and Medicaid/NCQA guidelines.

You will research appeals, prepare reviews, and coordinate with providers and facilities to ensure timely, compliant processing. This role requires 1–3 years in appeals processing or utilization management, RN licensure, and strong written communication.

Qualifications

• RN license and 1–3 years of appeals processing or utilization management experience.
• Knowledge of Medicaid and NCQA requirements.
• Strong written and reading comprehension and the ability to work independently.

Responsibilities

• Research appeals and prepare case reviews for Medical Directors.
• Ensure timely review and accurate processing of appeals according to State, Federal and NCQA standards.
• Communicate with providers, facilities and other departments about appeals.
• Support clinical reviews and recommendations on approvals/denials as needed.

Education

RN licensure

Job description

NTT DATA, Inc. in Manila, Quezon (PH-QUE), Philippines seeks a BPO Medical Records Specialist to support case reviews, medical directors, and Medicaid/NCQA guidelines.

You will research appeals, prepare reviews, and coordinate with providers and facilities to ensure timely, compliant processing. This role requires 1–3 years in appeals processing or utilization management, RN licensure, and strong written communication.