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Billing & Enrollment Analyst (Appeals & Denials)--Plano, TX

Expired Job

NTT Data Corporation Plano , TX 75023

Posted 5 months ago

At NTT DATA we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA Services and for the people who work here.

Req ID: 28231

We are looking for an Expert who has knowledge and skill to resolve all types of denials (clinical, technical and administrative denials), including the facilitation of extensive reviews of the medical records, resolution of technical denials with Insurance companies for issues such as authorization of services, timely filing etc.

Role Responsibilities:

  • Identify the root cause of denials and work with denial and AR teams to implement effective strategies and process improvements, to reduce costly delays in payment.

  • Ensuring direct and extended team members have appropriate skills and training to:

  • Validating denial reasons following Explanation of Benefits (EOB) review

  • Ensuring coding is accurate and reflects the denial reasons.

  • Coordinating with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary,

  • Generating appeals based on the dispute reason and contract terms specific to the payer, to include online reconsiderations.

  • Following specific payer guidelines for appeals submission.

  • Researching contract terms/interpretation and compile necessary supporting documentation for appeals, Terms & Conditions for account adjudication issues, and referral to refund unit on overpayments.

  • Examine and work with client to improve accuracy of adjudication systems, to ensure these are working properly to efficiently adjudicate claims. This includes examination of Billing and AR function processes to minimize denials

  • Perform research and makes determination of corrective actions and takes appropriate steps to code and route account appropriately.

  • Analyzing payer performance and providing reports (including bulk issues) to client and internal operations Performs elevated level contract overview to ensure accuracy of contract terms and conditions.

  • Solid understanding of reimbursement methodologies to review variances to expected reimbursement (debit and credit balances) based on established guidelines.

  • Ability to analyze, trend and escalate issues as needed to the appropriate stakeholders. Prepare inventory of accounts to provide client with clean actionable issues to drive payer results.

  • Interpret required reports (daily, weekly, monthly) to ensure optimum revenue recovery from claims.

  • Coordinate efforts with client to drive changes in auto adjudication, aging and cycle time.

  • Lead and participate in meetings as needed.

  • Provide feedback to internal operations and client regarding payer trend status resolution.

  • Provides concise documentation and reports to internal operations and client.

  • Assist in special projects to drive desired payer results.

  • Review bulletins and notifications from the payer on a timely basis and assess for business impact.

  • Prepare related communications to notify stakeholders.

Requirements:

Bachelors' degree, preferably in Healthcare management

Minimum of 4 years' experience as Denials manager in large multispecialty healthcare system

Prefer AAHAM certification as CRCE 1

This is a full-time salaried position with a group company within NTT DATA. Please note, 1099 or corp-2-corp contractors will NOT be considered. This position is only available to those interested in direct staff employment opportunities. We offer a full comprehensive benefits package that starts from your first day of employment.

This is a full-time salaried position with a group company within NTT DATA. Please note, 1099 or corp-2-corp contractors will NOT be considered. This position is only available to those interested in direct staff employment opportunities. We offer a full comprehensive benefits package that starts from your first day of employment.


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Billing & Enrollment Analyst (Appeals & Denials)--Plano, TX

Expired Job

NTT Data Corporation