Feature Of The Month

Job Details

Since these are all work from home, freelance, contract and telecommute jobs, you can be based anywhere and still apply, providing you meet the employer's requirements. However, there are times when the employer will ask for applicants from a specific location, this will be clearly stated in the job posting below.

Title: Medicare Benefit and Payment Expert
Date Posted: 2017-10-29
Location: Plano, TX
At NTT DATA Services, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company's growth, market presence and our ability to help our clients stay a step ahead of the competition. 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.

NTT DATA Services currently seeks a Medicare Benefit and Payment Expert to join our team in Plano, Texas (US-TX), United States (US), or in a Remote or Virtual location in the US.

NTT Data Services is looking for a Medicare Benefit and Payment Expert to join our BPO team. Ideally, you will provide expert knowledge for Medicare, Medicaid, and CMS beneficiary, have expertise in claims coding and payment policies & procedures to internal and external customers; this will include BPO configuration teams responsible for configuring these policies and procedures rules for accurate claims processing. You will collaborate with operational teams and customers to ensure effective impact assessment, accurate implementation and processing of regulatory updates and changes for each customer. This role requires strong analytical skills, effective communication skills and deep knowledge of Medicare policies and procedures primarily covered within the CMS Manuals and NCDs and LCDs. This position has substantial authority and responsibility for exercising independent judgment requiring extensive research, interpretation, and application of laws and regulations.


- Provide deep subject matter expertise related to Medicare and MA claim billing, coding, coverage determinations, reimbursement policies and procedures to provide critical analysis, review, and guidance to internal and external customers
- Oversee the Medicare regulatory monitoring obligations and process, including monitoring and interpreting CMS regulations, guidance and changes related to Medicare materials, including CMS transmittals, prospective payment, outpatient payment systems, coding edits, coverage determinations
- Review, analyze, and effectively communicate impacts of CMS changes to policies and procedures summarizing impacts to internal and external customers to the operations team.
- Work with business units to assess potential impact to achieve compliance.
- Evaluate contractual obligations, collaborating with internal and external leaders, on best practice and recommended changes
- Develop and maintain policy and process artifacts for monitoring and tracking published regulatory changes in accordance with identified obligations, performing timely evaluations and updates to the policy and processes used
- Addresses questions, review issues, and support carrier audits on Medicare compliance matters focused as requested
- Employs a "hands on" approach to issue identification and resolution, utilizes various tools to assess claim data quality.
- Mentor and guide other team members on the subject matter to develop broader knowledge within the team
- Ability to consult on the intent of updates to meet CMS requirements.
- Provides leadership and expertise on various projects focused on enhancements to the overall Medicare product domain in support of changing CMS requirements.
- Broaden expertise in Medicare beyond claims payment and reporting functions

Basic Requirements:

- 10+ years' experience in the Medicare and Medicaid domain performing similar duties
- In depth and comprehensive knowledge of government payer policies, rules and regulations.
- Understanding of calculations within Medicare payment systems like DRG, APC, DME, home health, rehab
- Comprehensive knowledge of policy application in a claims processing environment, medical policy and benefit coverage, provider contracts, and reimbursement methodologies.
- Strong analytical skills and problem-solving skills
- Effective and persuasive written and verbal communication skills
- Proficiency with Microsoft Office products

Preferred Requirements:

- Bachelor's degree with 8+ years equivalent work experience
- Clinical experience with similar responsibilities or Certified Professional Coder - Payer (CPC-P(r)) a plus; Claims coding knowledge and experience with CPT, HCPCS, ICD9/10, CDT, Revenue, DRG and other relevant medical and dental industry-standard codes
- Implementation of payment systems in common payer systems like Ingenix/Optum, ikaClaims, Facets, Xcelys is a plus

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

About NTT DATA Services

NTT DATA Services partners with clients to navigate and simplify the modern complexities of business and technology, delivering the insights, solutions and outcomes that matter most. We deliver tangible business results by combining deep industry expertise with applied innovations in digital, cloud and automation across a comprehensive portfolio of consulting, applications, infrastructure and business process services.

NTT DATA Services, headquartered in Plano, Texas, is a division of NTT DATA Corporation, a top 10 global business and IT services provider with 100,000+ professionals in more than 50 countries, and NTT Group, a partner to 85 percent of the Fortune 100. Visit nttdataservices.com to learn more.

NTT DATA, Inc. (the "Company") is an equal opportunity employer and makes employment decisions on the basis of merit and business needs. The Company will consider all qualified applicants for employment without regard to race, color, religious creed, citizenship, national origin, ancestry, age, sex, sexual orientation, genetic information, physical or mental disability, veteran or marital status, or any other class protected by law. To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship to the Company would result.

Apply via this link only:

keywords: medicare benefit expert, medicare payment expert


Like us on Facebook

Follow us on Twitter
Company: NTT DATA, Inc.
Contact person: Not mentioned
Contact information: info@nttdata.com (DO NOT APPLY VIA THIS EMAIL ADDRESS)