NTT

3 weeks ago

BPO Medical Records Specialist

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Last checked: 21 hours agoStatus: Live

Job Summary

Review and manage medical claim appeals for Medicaid-related cases by researching appeal requests, applying clinical and policy criteria, and preparing recommendations for Medical Directors. Ensure timely, accurate processing and communication of appeal resolutions to members and providers in line with State, Federal, and NCQA standards. May perform clinical reviews, maintain appeal files, and partner with teams to improve consistency, efficiency, and appropriateness of appeals processing.

Location: Manila

Workplace: Onsite

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Entry level

Key Responsibilities

•Research appeal requests, review applicable criteria, and prepare case reviews for Medical Directors.
•Ensure timely, accurate appeal review, processing, and responses in accordance with State, Federal and NCQA standards.
•Review claim appeals for reconsideration, recommend approvals/denials, and support medical review presentations.
•Communicate with providers, facilities, and internal departments regarding appeal requests and resolutions.
•Maintain files on individual appeals and collaborate with leadership to improve appeal consistency, efficiency, and appropriateness.

Key Requirements

•1-3 years of experience in processing appeals or utilization management.
•1 year experience in advanced roles such as team lead, trainer, SME, or QA.
•RN (Registered Nurse) with state-required licensure and/or Compact State Licensure.
•Knowledge of utilization management processes and NCQA/Medicaid regulations.
•Strong reading comprehension and writing skills, plus the ability to work independently with analytical skills.

Skills:CommunicationAnalytic skillsIndependent workReading comprehensionWriting

Licenses:RN - Registered Nurse

Company Brief

NTT

Dimension Data, operating under NTT Ltd, provides managed IT services, cloud and data center solutions, networking, cybersecurity, and digital transformation services to enterprise customers worldwide.

Industry: Professional Services

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Established Company

Valuation: Public Company (Market Cap in USD)

Headquarters: London, United Kingdom

Founded: 1983

Website LinkedIn

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NTT