What are the responsibilities and job description for the Business Analysis Advisor position at NTT DATA Group Corporation?
NTT DATA's Client is currently seeking a Business Analysis Advisor to join their team in Annapolis, Maryland (US-MD), United States (US).
Minimum 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and / or quality management, or any combination of education and experience, which would provide an equivalent background.
ctive nursing license (BSN or RN), and professional certification in Utilization Management is preferred
Familiarity with Utilization Management Guidelines, ICD-10 and CPT-4 coding, and managed health care including HMO, PO and POS plans.
Previous utilization and / or quality management preferred
Strong analytical and critical thinking skills, with an attention to detail
Excellent interpersonal skills, with the ability to communicate effectively with healthcare professionals and patients
bility to maintain accurate records and documentation of all reviews and case outcomes
Excellent communication skills, including the ability to communicate complex medical information to diverse audiences
bility to work independently and as part of a team in a fast-paced environment
Proficient computer skills and experience with electronic health records
Job description-
Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or supports the level of care rendered or requires additional medical necessity review.
Review medical records, lab results, and other clinical information to ensure compliance with established standards and guidelines
Provide complex clinical information to insurance carriers and healthcare providers to support reimbursement decisions
Notifies ordering physician or rendering service provider office of the preauthorization determination decision
Follows-up to obtain additional clinical information.
Ensures proper documentation, provider communication, and telephone service per department standards and performance metrics.
bout NTT DATA :
NTT DATA is a $30 billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize and transform for long term success. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure and connectivity. We are one of the leading providers of digital and AI infrastructure in the world. NTT DATA is a part of NTT Group, which invests over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. Visit us at us.nttdata.com
NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.
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