Dental Prior Approval Reviewer

Clearance Level
Healthcare Claims
Raleigh, North Carolina

REQ#: RQ75456 Dental Prior Approval Reviewer (Open)

Travel Required: None
Public Trust: None
Requisition Type: Regular
Job Description

GDIT NCMMIS is a claims processing system for the North Carolina Department of Health and Human Services (NC DHHS) to which North Carolina citizens have become entitled through enrollment in benefit plans offered by the State of North Carolina.  The NCMMIS call center supports this system by handling inbound calls from hospitals and physicians concerning claims and enrollment inquiries.

The program is seeking a Dental Prior Approval Reviewer to analyzes dental prior approval requests for North Carolina Medicaid to ensure compliance with organizational and government guidelines.

Minimum Requirements:

Requires active North Carolina license as a Registered Dental Hygienist.

5+ years of clinical dental hygiene experience.

The ideal candidate will have:

Knowledge of business processes of NC DHHS and/or Health Choice.

Ability to work independently to meet service level agreements within the contract and individual performance standards.

Knowledge of Microsoft Outlook and Office.

Experience using NCTracks is a plus.

We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.

GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.