HC & Insurance Operations Senior Assoc. @ NTT Global Delivery

Job Description

Position General Duties:

Team leader to assist Centene with Provider Data Management and Provider Data Enrollment Resources to the Client main application according to its policies and procedures defined.

Role Responsibilities :

• In-depth knowledge and experience in the US healthcare (Non Voice) Provider Data Validation and Provider Data management.
• Monitor team production, SLA and KPI and ensure client deliverables are met as per the contract.
• Keep the Standard operating procedure updated and establish due control mechanism.
• Work with quality and business transformation team to identify, recommend and implement process improvement projects.
• Monitoring and reporting team performance as needed set a right goal for all the team members.
• Provide mentorship, coaching and training to the team on all process related updated.
• Circulate productivity and quality dashboards at agreed periodic intervals to all relevant stakeholders.
• Proven track record in managing processes, streamlining workflows and excellent people management skills.
• Presenting the data and provide deep insights about the process to the clients as well as internal management
• Calibrate with QA s to ensure process knowledge and variance are managed and under control.
• Knowledge in Amisys and Cenprov application are preferred.
• Product knowledge in checking affiliation for Medicaid, Medicare and Exchange.
• Everyday checked Contract information in Payment Index such as, Pay class, override key, accepts code and etc.
• Ability to read and understand the provider contract.
• Handling Paid claims and recouped claims.
• Claims Rejections handling.
• Working in claims denial management.
• Knowledge about End to End provider billing process.
• Working knowledge in EDI rejection claims
• Handing Patient and provider demographic changes.

Required Skills :

• 8+ years of experience in US healthcare working with Provider Data Management
• Ability to work regularly scheduled shifts from Monday-Friday 17:30pm to 3:30am IST.
• University degree or equivalent that required 3+ years of formal studies.
• Ability to work in a team environment.
• Good logical thinking ability.
• Good English Comprehension/written skills should have exposure to MS Office.
• Good Communication Skills Both Verbal and Written
• Ability to interact with clients preferred.

**Required schedule availability for this position is Monday-Friday 6PM/4AM IST The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on wend s basis business requirement.

Employement Category:

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Keyskills:   standard operating procedure us healthcare data management data validation team performance quality assurance people management managing processes process improvement communication skills business transformation qa edi pay sla kpi set claims amisys statements of work sow