NTT DATA Services

NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers, and application services. Our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.

Claims Examiner

Location

United States

Posted

6 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Claims Examiner

NTT DATA Services

Role Description We are currently seeking a Claims Examiner - Xcelys Remote, Temporary to join our team in Ontario, California (US-CA), United States. - Reviews written dispute requests received from providers of denied or incorrect payments based on contractual arrangements with providers and non-contractual providers regarding either Professional or Institutional Claims. - Ability to interpret provider and health plan contracts to ensure accurate payment of claims or denial of services based on the terms of the provider contract and the financial responsibility as set in the health plan contract, including RBRVS and Medicare guidelines as it applies to contracted and non-contracted providers. - Adjust claims, as appropriate, including calculation of interest and penalties due when applicable. - Ability to identify potential issues related to system configuration, benefits, eligibility, authorizations, etc., affecting the Claims Department's ability to process claims accurately and forwarding those issues to the correct internal department, attaching all necessary documentation, to ensure the system is updated, as appropriate and follow-up with these departments. - Plan and organize workload to ensure efficient and compliant resolution of issues. - Communicate to Provider in writing for all disputes utilizing system formatted letters in a clear and concise manner in accordance with all guidelines set by the department. - Responsible for requesting special check run requests to ensure compliance. - Warning reports are monitored daily to ensure compliance. - Provider education calls completed based on outcomes of PDR. - Responsible for documenting each dispute in Provider Dispute Database accurately for reporting purposes for management reports to all customers internally and externally as required by AB1455. - Maintain minimum standards set for the department for quality and quantity of appeals received. - Update Provider Dispute Database with the outcome resolution of issues as appeals are completed. - Responsible for keeping Team Supervisor aware of potential problem issues for our education to all departments involved with claim issues. - Advise management of issues identified which have an impact on accurate processing or system configuration of claims per contracts or guidelines for non-contracted providers. - Any other assigned duties delegated by the Management. Qualifications - Exceptional, innovative, and passionate individuals who want to grow with us. Requirements - Ability to interpret provider and health plan contracts. - Experience with RBRVS and Medicare guidelines. - Strong communication skills for written disputes. - Ability to identify and forward potential issues. - Organizational skills for workload management. Benefits - Flexible work options, including remote or hybrid arrangements. - Access to a robust ecosystem of innovation centers. - Opportunities for professional growth and development.

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