Behavioral Health Membership Analyst
Candidate can reside anywhere in the US (must be able to work 9-5:30 MST)
Position Summary:
Analyst position would work within the Commercial and Individual Family Plan (IFP) membership of the Behavioral Health Division of Healthcare/Pharmacy dept. Would work closely with Medical Directors, Clinicians and Customer Service to process higher level reviews. The Analyst would be an integral part of managing our state policies, our NCQA accreditation, and helping our members get the help and documentation that they need.
Duties:
- Provide service to clinical teams in support of optimal care.
- Generates administrative and medical necessity denial letters, checking for accuracy and appropriateness.
- Makes calls to providers and utilization reviewers to provide results of medical necessity determinations and provides specifics for next steps.
- Schedules and coordinates appointments between providers or attending physicians and Healthcare Medical Directors or Consultants.
- Collects and provides necessary material for appointments. Calculates deadlines for appointments and monitor cases for timely return.
- Complies with state mandated and Healthcare regulations by monitoring documentation, checks for nuances before action taken and follows varying protocols by case or situation.
Required Qualifications:
- 2 plus years experience in health insurance field and/or
- 2 plus years Administrative/ Secretarial experience and/or
- 2 plus years Customer service experience within health care or a mental health capacity
- Ability to type 60-70 words per minute (please included typing test at top of resume)
- Experience in using Microsoft Office including Word, Outlook and Excel
Preferred Qualifications:
- Good organizational skills
- A go-getter who works independently
- Excellent communication
Education:
Associates Degree or higher
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 28.00- 35.00 . 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.
This position may also be eligible for incentive compensation based on individual and/or company performance.
This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits .