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Client Services Specialist I

2 months ago

Providence, United States NTT DATA Group Corporation Full time

Coverage Determination Rep I (Client Service Rep I)

Opportunity for full-time employment contingent on performance
Virtual interviews with supervisors via WebEx or phone.
Hours of operation 8-8 est M-F with rotating weekend schedules

Job Summary:
The Coverage Determination Representative I will work closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or lines of business 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 Learning Advocates and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility and additional cross training to learn all lines of business. Flexibility for movement to different parts of the business to support volume where needed.

In this role, you will be responsible for:
• Utilizing multiple software systems to complete Medicare appeals case reviews
• Meeting or exceeding government mandated timelines
• Complying with turnaround time, productivity and quality standards
• Conveying resolution to beneficiary or provider via direct communication and professional correspondence
• Acquiring and maintaining basic knowledge of relevant and changing Med D guidance

Minimum Qualifications:
1 year of healthcare or pharmacy experience
1 year of experience with Medicare, medicaid or commercial insurance
1 year of customer serice experience.

Preferred Qualifications:
• Accountable and results driven
• Critical thinker/problem solver
• Receptive to constructive feedback and flexible in adapting to change
• Ability to effectively plan, prioritize, and organize time and workload
• Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment
• Ability to sit at desk/station and focus on reviews for entire shift
• Proficient in navigation of multiple computer applications
• Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors
• Ability to type more than 30 WPM
High School Diploma or GED

About NTT Data Services:

NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.

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 . 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.