Remote Medicare Coverage Determination Rep I

JobDiva, Inc.; Woonsocket (RI); Remote; USD 25,000 - 39,000; Full time

Job summary

NTT DATA is seeking a Coverage Determination Rep I to join our team remotely in the US. The role focuses on Medicare Prior Authorization case reviews using multiple software systems, with emphasis on meeting government timelines and maintaining quality standards.

Responsibilities include triaging data-entry queues, researching reports, maintaining accurate documentation, and escalating issues to pharmacists or management as needed.

Qualifications

• 1 year minimum, medical insurance background.

Responsibilities

• Review Fax documents appropriately and forward to appropriate queues
• Update and maintain knowledge of relevant process, regulation and clinical material.
• Provide assistance or guidance in partnership with learning and innovation when needed
• Participate in developmental discussions receiving feedback with Supervisor

Skills

Medicare Prior Authorization

Data entry

Education

High School diploma or GED

Job description

NTT DATA is seeking a Coverage Determination Rep I to join our team remotely in the US. The role focuses on Medicare Prior Authorization case reviews using multiple software systems, with emphasis on meeting government timelines and maintaining quality standards.

Responsibilities include triaging data-entry queues, researching reports, maintaining accurate documentation, and escalating issues to pharmacists or management as needed.