Coordinator III - Customer Service Rep - NTT DATA
Kansas City, KS 02895
About the Job
NTT DATA Services currently seeks a Healthcare Customer Service Rep to join our team in Kansas City, KS. This is a 6+ month work from home contract role but mut be able to commute to the office in Overland Park, KS if any technical issues.
In this role 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.
Role Responsibilities
-Answers questions and resolves issues based on phone calls/letters from members, providers, and other departments. Documents and tracks contacts with members, providers and plan sponsors.
-Guides the member through their members plan of benefits, Healthcare policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
-Explains member's rights and responsibilities in accordance with contract.
-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.
Required Skills/Experience
2+ years Customer Service experience in a transaction based healthcare environment such as a call center or retail location.
2+ years working in a production healthcare environment.
2+ years experience in MSWord and MSExcel.
2+ years medical terminology and medical coding.
2+ years reading and interpreting billing documents.
2+ years data entry experience.
Preferred skills:
-Ability to creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health.
-Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs.
Hours: 8am-5pm-may vary
Education: Verifiable high school diploma or GED
About NTT DATA Services:
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.
#INDHRS
In this role 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.
Role Responsibilities
-Answers questions and resolves issues based on phone calls/letters from members, providers, and other departments. Documents and tracks contacts with members, providers and plan sponsors.
-Guides the member through their members plan of benefits, Healthcare policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
-Explains member's rights and responsibilities in accordance with contract.
-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.
Required Skills/Experience
2+ years Customer Service experience in a transaction based healthcare environment such as a call center or retail location.
2+ years working in a production healthcare environment.
2+ years experience in MSWord and MSExcel.
2+ years medical terminology and medical coding.
2+ years reading and interpreting billing documents.
2+ years data entry experience.
Preferred skills:
-Ability to creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health.
-Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs.
Hours: 8am-5pm-may vary
Education: Verifiable high school diploma or GED
About NTT DATA Services:
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.
#INDHRS
Source : NTT DATA