RN Medical Records & Appeals Specialist | US Day Shift

NTT DATA, Inc.; Adya; Hybrid; PHP 360,000 - 600,000; Full time

Job summary

NTT DATA, Inc. is seeking a BPO Medical Records Specialist in Manila, Philippines. You will research, review criteria, and prepare case reviews for Medical Directors, ensuring timely, accurate processing of Medicaid and NCQA standards.

Collaboration with providers and departments is essential to drive compliant outcomes. The role requires RN licensure and 1–3 years in appeals or utilization management, with strong communication and analytical skills and the ability to work independently.

Qualifications

• Active RN license required.
• 1-3 years of appeals or utilization management experience.
• Knowledge of NCQA and Medicaid regulations.
• Strong communication and analytical skills.
• Ability to work independently and manage time effectively.

Responsibilities

• Guide on preparing case reviews for Medical Directors by researching the appeal and criteria.
• Prepare case reviews for Medical Directors and analyze appeal basis.
• Ensure timely review and accurate processing of appeals per standards.
• Review claims appeals for reconsideration and recommend approvals/denials.
• Communicate with providers, facilities, and departments regarding appeals.

Skills

Strong communication

Analytical skills

Independent work

US shift availability

Education

RN - Registered Nurse Licensure

Job description

NTT DATA, Inc. is seeking a BPO Medical Records Specialist in Manila, Philippines. You will research, review criteria, and prepare case reviews for Medical Directors, ensuring timely, accurate processing of Medicaid and NCQA standards.

Collaboration with providers and departments is essential to drive compliant outcomes. The role requires RN licensure and 1–3 years in appeals or utilization management, with strong communication and analytical skills and the ability to work independently.