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Healthcare Coverage Determination Specialist

2 months ago

Providence, Rhode Island, United States NTT DATA Full time
Job Summary

NTT DATA is seeking a skilled Healthcare Coverage Determination Representative II to join our team. As a key member of our team, you will work closely with healthcare providers to process prior authorization requests and ensure compliance with Medicare Part D CMS Regulations.

Key Responsibilities
  • Process prior authorization requests for healthcare services and medications
  • Research and resolve issues related to coverage determinations
  • Communicate with healthcare providers to obtain additional information
  • Maintain accurate records and data entry
  • Collaborate with clinical pharmacists and management team to resolve complex issues
Requirements
  • At least 2 years of general business experience with problem resolution, business writing, and customer service
  • At least 1 year of Medicare Prior Authorization experience
  • 6+ months of experience working in a virtual role
Preferred Qualifications
  • Strong attention to detail and excellent communication skills
  • Proficient computer skills and ability to navigate Windows-based environment
  • Ability to work in a high-pressure, time-sensitive environment
  • Strong organizational and problem-solving skills
About NTT DATA

NTT DATA is an equal opportunity employer and values diversity and inclusion in the workplace. We are committed to creating a work environment that is free from discrimination and harassment. If you need assistance or an accommodation due to a disability, please inform your recruiter.