Delivery Senior Manager

Applicable Limited; Plano (TX); Remote; USD 101,000; Full time

Job summary

An established industry player is seeking a Delivery Senior Manager to lead Medicare Appeals service delivery. This role involves enhancing workstream efficiency, collaborating with various stakeholders, and ensuring compliance with Medicare regulations. The ideal candidate will possess strong analytical and problem-solving skills, along with a deep understanding of clinical appeals. Join a forward-thinking organization that values innovation and offers comprehensive benefits, including medical, dental, and vision insurance. This is a fantastic opportunity to make a significant impact in the healthcare sector while working in a supportive environment.

Benefits

Medical insurance

Dental insurance

Vision insurance

401k program with company match

Paid time off

Life insurance

Short-term disability coverage

Long-term disability coverage

Employee assistance programs

Qualifications

• 8 years of health plan appeals experience, specifically in clinical appeals.
• Strong clinical knowledge and ability to interpret medical records.

Responsibilities

• Develop and implement strategies to improve workstream efficiency.
• Collaborate with leadership on service delivery design and requirements.
• Stay updated on Medicare appeals regulations and guidelines.

Skills

Medicare policies

Clinical appeals

Analytical skills

Problem-solving

Communication skills

Leadership

Education

Bachelor’s degree

Job description

Req ID:318029

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.

We are currently seeking a Delivery Senior Manager to join our team.

NTT DATA is seeking to hire a Medicare Appeals Clinical Leaderto lead service delivery engagements and improve end-to-end delivery of Medicare Appeals. Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end delivery of services.

This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, flexible spending or health savings account, life and AD&D insurance, short- and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.

Pay for this role is $100,500.00 Salary

In this Role the candidate will be responsible for:

• Develop and implement strategies to improve workstream efficiency and quality.
• Collaborate with internal and external leadership on overall service delivery design and requirements for successful performance
• Stay updated on Medicare appeals regulations and guidelines from CMS collaborating with customers that all appeals are handled in accordance with federal and state laws.
• Identify potential compliance risks and implement corrective actions
• Collaborate with health plans, clinical teams, utilization management, and other departments to address complex cases and identify trends.
• Establish communication plans with various levels of customer organizations regarding performance, metrics, and processes.
• Track appeal metrics, including case volumes, resolution times, and denial rates.
• Analyze processes to identify and recommend improvements, especially related to clarity of written recommendations and interpretations of records.
• Prepare reports for senior management on appeal trends and compliance status.

Requirements:

• Requires Bachelor’s degree
• 8years of health plan appeals experience, specifically in clinical appeals
• Deep understanding of Medicare policies, coverage guidelines, and appeals process

• Strong clinical knowledge and ability to interpret medical records, documenting recommendations to uphold or overturn denials
• Excellent analytical and problem-solving skills
• Strong communication and presentation to interact with diverse stakeholders at various organization levels
• Leadership experience in managing a team and achieving results
• Experience with healthcare regulations and compliance requirements
• Ready to Travel upto 25%.

Preferred Skills & Experiences:

• Presentation and communication experience, creating decks to convey topics including status, value, processes
• Advanced organizing and planning skills to oversee project deliverables.
• Advanced priority setting and delegation skills.
• Advanced analytical, problem solving, negotiation and communication skills

New hires must have a working device (such as cell phone or tablet) for the 2-Factor Authentication process.

Must Pass Drug screen.

Must Pass a background check with Education check and employment verification check.

Remote Working and Technology Requirements

To work remote, individuals must meet all the established Remote requirements including those pertaining to a home workspace and related technology.

Technology

• NTT DATA will provide a computerand headset for remote work.
• Employees are responsible for the care and security of all equipment provided. They must return it immediately upon separation from the company following company protocols.
• Failure to return equipment may result in collection actions and/or other consequences.
• Individuals must provide their own high speed internet access with speeds at or above 50 Mbps.
• A hard-wired ethernet connection is required. Wi-Fi, mobile, wireless and public internet connections are forbidden as are connections outside of one’s personal dwelling or location.

Technical Performance and Issue Tracking

• Management monitors all technical issues and agent downtime. Consistent availability is critical to business operations.
• Remote employees must adhere to all technical support procedures and protocols.
• Chronic connectivity issues or recurring downtimethat impede job performance, including internet outages, may result in the remote status changing to onsite.

Remote Workspace

Remote work demands a high degree of professionalism, self-discipline, and accountability. The following workspace standards are vital to delivering exceptional service.

• Employees must have adedicated, professional workspaceconducive to servicing Customer Service customers with the same quality as an onsite environment.
• The workspace must be apermanent, unencumbered locationused daily for work.
• Employees must work withminimal distractionsthat do not interfere with business operations or service delivery.
• Ideally, the workspace isisolated from other household membersand used exclusively for job duties.
• Background noise, interruptions from people or pets, and other distractionsmust be kept to an absolute minimum to avoid disruptions to customer service.
• Employees must work from thesame location consistentlyunless prior approval is obtained.
• If a change in work location is necessary:
• The new location must meet allRemote Workspace and Technology Requirements.
• Notification to NTT DATA Managementis required before relocating

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About NTT DATA

NTT DATA is a $30 billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize and transform for long term success. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies.Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure and connectivity. We are one of the leading providers of digital and AI infrastructure in the world. NTT DATA is a part of NTT Group, which invests over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. Visit us atus.nttdata.com

NTT DATA endeavors to make https://us.nttdata.comaccessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at https://us.nttdata.com/en/contact-us.This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.