Coverage Determination Representative II
REMOTE US
Must be US Authorized, W2 only
8hr Shift Mon- Fri 8a-8p EST, rotating weekends.
Mandatory Video Training hours M-F 9a-5:30p EST Up to 8 weeks duration.
Position Summary:
The Healthcare Coverage Determination Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of Healthcare as the client and in accordance with Medicare Part D CMS Regulations. Must apply information [provided through multiple channels] to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
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Duties:
Customer service focus. Basic experience in MSWord and MSExcel. Familiar with medical terminology and knowledge of medical coding. Ability to read and interpret billing documents. The position also requires an extensive amount of data entry work.
Minimum Qualifications:
• At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service
• At least 1 year of Medicare Prior Authorization experience.
• Six months of working in a virtual role where the supervisor is not physically in the same space
• Six months of PBM/pharmaceutical Medicare benefits related work
Preferred Qualifications:
1.Strong Attention to detail
2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality
3.Proficient computer skills and the ability to navigate in a Windows based environment
4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible
5.Ability to work in a high pressure, time sensitive environment
6.Project a professional business image, through phone interaction as well as internal communications 7.Demonstrated problem-solving ability and attention to detail
8.Demonstrated sense of urgency with assignments
9.Strong organizational skills
10.Strong telephone skills
11.Ability to read and understand pharmacy/medical terminology
12.Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations.
13.Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required
14.Ability to interpret a variety of work instructions provided through a variety of mediums
15.Ability to anticipate needs and resolve issues with urgency
16.Ability to consistently meet quality and production standards
17.Displays confidence in the ability to learn complex material
18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results
Education:
High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.
About NTT Data Services:
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.
NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.
Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is 17.75. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on a number of factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance.
This position may also be eligible for incentive compensation based on individual and/or company performance.
This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, 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 .