Representative II- Coverage Determination Representative II - NTT DATA : Job Details

NTT Data seeking Coverage Determination Reps for a 1 year remote contract role.Start date for this role is 11/4/2024.8 hour shifts will be assigned between 8a-8p EST Mon-Friday with a rotating weekendVideo Training hours M-F 9a-5:30p EST 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.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.• 6+ months working in a virtual role where the supervisor is not physically in the same spacePreferred Qualifications:1.Strong Attention to detail2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality3.Proficient computer skills and the ability to navigate in a Windows based environment4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible5.Ability to work in a high pressure, time sensitive environment6.Project a professional business image, through phone interaction as well as internal communications 7.Demonstrated problem-solving ability and attention to detail8.Demonstrated sense of urgency with assignments9.Strong organizational skills10.Strong telephone skills11.Ability to read and understand pharmacy/medical terminology12.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 required14.Ability to interpret a variety of work instructions provided through a variety of mediums15.Ability to anticipate needs and resolve issues with urgency16.Ability to consistently meet quality and production standards17.Displays confidence in the ability to learn complex material18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate resultsEducation:Verifiable High School Diploma or GED required.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 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 .#INDHRS