Delivery Senior Manager

NTT DATA, Inc.; Plano (TX); Remote; USD 101,000; Full time

Job summary

Join a forward-thinking organization as a Delivery Senior Manager, leading the charge in enhancing Medicare Appeals service delivery. This role requires a blend of clinical expertise and leadership to navigate the complexities of health plan appeals, ensuring compliance with regulations while driving efficiency. With a commitment to innovation and excellence, you'll collaborate with diverse teams to tackle challenges and implement solutions that make a real difference. If you're passionate about making an impact and growing in a dynamic environment, this opportunity is for you.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Flexible Spending Accounts

Life Insurance

Short-term Disability

Long-term Disability

Paid Time Off

401k Plan with Company Match

Employee Assistance Programs

Qualifications

• 8+ years of health plan appeals experience, specifically in clinical appeals.
• Deep understanding of Medicare policies and appeals process.

Responsibilities

• Developing strategies to improve workstream efficiency and quality.
• Collaborating on service delivery design and requirements.

Skills

Health Plan Appeals Experience

Medicare Policies Knowledge

Analytical Skills

Communication Skills

Leadership Experience

Problem-Solving Skills

Job description

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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 Leader to lead service delivery engagements and improve end-to-end delivery of Medicare Appeals. Experience specifically related to processes for clinical appeals coordinators is desired, but this role will focus on leading the end-to-end delivery of services.

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

Pay for this role is $100,500.00 annually.

In this role, the candidate will be responsible for:

• Developing and implementing strategies to improve workstream efficiency and quality.
• Collaborating with internal and external leadership on service delivery design and requirements for successful performance.
• Staying updated on Medicare appeals regulations and guidelines from CMS, ensuring all appeals are handled in accordance with federal and state laws.
• Identifying potential compliance risks and implementing corrective actions.
• Collaborating with health plans, clinical teams, utilization management, and other departments to address complex cases and identify trends.
• Establishing communication plans with various levels of customer organizations regarding performance, metrics, and processes.
• Tracking appeal metrics, including case volumes, resolution times, and denial rates.
• Analyzing processes to identify and recommend improvements, especially related to clarity of written recommendations and interpretation of records.
• Preparing reports for senior management on appeal trends and compliance status.

Requirements:

• 8+ years 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 skills to interact with diverse stakeholders at various organizational levels.
• Leadership experience in managing a team and achieving results.
• Experience with healthcare regulations and compliance requirements.
• Willingness to travel up to 25%.

Preferred Skills & Experiences:

• Experience in creating presentations and communication materials, including status updates, value propositions, and process descriptions.
• Advanced organizational and planning skills to oversee project deliverables.
• Advanced prioritization and delegation skills.
• Strong analytical, problem-solving, negotiation, and communication skills.

Additional Requirements:

• Must have a working device (such as a cell phone or tablet) for the 2-Factor Authentication process.
• Must pass a drug screening.
• Must pass a background check, including education verification and employment history.

Remote Working and Technology Requirements:

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

Technology:

• NTT DATA will provide a computer and headset for remote work.
• Employees are responsible for the care and security of all provided equipment and must return it upon separation from the company as per protocols.
• Failure to return equipment may result in collection actions or other consequences.
• High-speed internet access (at least 50 Mbps) and a hard-wired ethernet connection are required; Wi-Fi, mobile, wireless, and public internet connections are not permitted outside of a personal dwelling.

Technical Performance and Issue Tracking:

• Management monitors all technical issues and downtime. Consistent availability is essential for operations.
• Remote employees must adhere to all technical support procedures.
• Chronic connectivity issues or recurring outages that impede job performance may lead to a change in remote status to onsite.

Remote Workspace:

Remote work requires professionalism, self-discipline, and accountability. Standards include:

• A dedicated, professional workspace conducive to high-quality customer service.
• A permanent, unencumbered location used daily for work.
• Minimal distractions that do not interfere with operations.
• An isolated environment from household members, used exclusively for work.
• Minimizing background noise and interruptions.
• Consistent work location unless prior approval for change is obtained.

If relocating, the new location must meet all remote workspace and technology standards, and management must be notified beforehand.

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About NTT DATA

NTT DATA is a $30 billion global leader in business and technology services, serving 75% of the Fortune Global 100. We are committed to innovation, optimization, and transformation, with a presence in over 50 countries. Our offerings include consulting, data and AI, industry solutions, and application and infrastructure management. As part of NTT Group, which invests heavily in R&D, we aim to help organizations and society confidently and sustainably transition into the digital future. Visit us at https://us.nttdata.com

We strive to make our website accessible. For assistance or accommodations, contact us at https://us.nttdata.com/en/contact-us. NTT DATA is an equal opportunity employer, considering all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. For more information, see our EEO policy and related resources.

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