Healthcare and Insurance Operations Analyst

HC and Insurance Operations Analyst

ENROLLMENT & BILLING - GRADE 6

                                HC & INSURANCE OPERATIONS ANALYST

 

Position Overview:

 

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 and for the people who work here.

 

 

NTT DATA Services currently seeks a “HC & INSURANCE OPERATIONS ANALYST” to join our team in “CHENNAI”

 

Position General Duties:

 

Eligibility & Accounting representatives to assist Centene with Enrollment & Billing (EMB) Back Office activities for Medicaid LOB.

 

Role Responsibilities:

 

• In-depth knowledge and experience in the US healthcare (Non Voice) – Membership enrollment and billing.
• Ability to train the team on new process and process updates.
• Calibrate with QA’s to ensure process knowledge and variance are managed and under control.
• Ability to create Process SOP, Process Map and identifying the outlier within process.
• Review Discrepancy report and comments, identify gaps and share with TL.
• Identify NVA and provide suggestion for automation opportunities.
• Identify refresher/re-trainable topics, conduct assessments, and certify staff to move to different levels of production.
• Drive team from the front in case of leadership unavailability.
• Need to co-ordinate with quality team to identify the root cause and provide appropriate solution to overcome errors.
• Oversee data integrity of member enrollment records and remittance files transmitted from the state.
• Provide timely, efficient support for the eligibility load process while coordinating with corporate IS department to resolve issues that arise during the process.
• Provide research to correct errors in membership and Primary Care Physician data output within the provider information system.
• Research information on members/subscribers to resolve problems and disputes.
• Maintains quality and production standards as outlined by government regulations and department policies & procedures.
• Completion of volumes in queue within specified Turn Around Time.
• Ability to meet their required production and Quality target.
• Setting productivity /Quality benchmark
• Handles internal and external inquiries concerning billing, enrollment of member or subscriber.

 

 

Required Skills:

 

• Ability to work regularly scheduled shifts from Sunday - Saturday 5 PM IST time to 8 AM IST (5 days working).
• University degree or equivalent that required 3+ years of formal studies.
• Work from Office.
• No transport facility (Own transport).
• Ability to work in a team environment.
• Good logical thinking ability.
• Good English Comprehension/written skills should have exposure to MS Office.
• Good Communication Skills – Both Verbal and Written
• Ability to interact with clients preferred.

 

  ** Schedule availability for this position is Sunday - Saturday 5 PM IST time to 8 AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime, holiday working and weekend working as per business requirement.

Experience Level

Mid Level