Healthcare Claims Examiner (RN Required)

Clearance Level
None
Category
Healthcare Claims
Location
Remote, Based in the USA

REQ#: RQ125051

Travel Required: None
Requisition Type: Pipeline

General Dynamics Information Technology and CSRA have united to create the premier provider of high-tech IT solutions to the government IT market. Together as General Dynamics Information Technology, we deliver cost-effective, next-generation IT solutions and services to the Department of Defense, the intelligence community and federal civilian agencies as they modernize their information systems.

GDIT is currently seeking a Healthcare Claims Examiner in Raleigh, North Carolina to join our team. In this role you will be a change agent by evaluating the appropriateness of beneficiaries' admission to nursing facilities.

RESPONSIBILITIES:

  • Verify receipt of documentation that supports the medical necessity of prior approval requests for admission into lo
  • Evaluate accuracy and timeliness of documentation submitted for prior approval requests
  • Meet daily expected performance expectations by completing at least 40 prior approval reviews daily
  • Meet quality expectations of greater than 95% accuracy on quality assurance reviews
  • Meet service level agreement of timely reviews by completing the reviews within 24 hours
  • Meet timely updating of the system with pre-admission screening numbers within 24 hours of review

QUALIFICATIONS:

Required Skills and Experience - 

  • Requires active North Carolina Registered nurse license or Compact license with at least 2 years of clinical experience
  • Knowledge of Microsoft Office and Outlook
  • Experience with medical documentation review

Desired Skills and Experience:

  • Prefer to have knowledge of NCTracks
  • Prefer to have knowledge of business processes of North Carolina Division of Medicaid
  • Prefer clinical medical, surgical and nursing facility experience
  • Prefer clinical research experience  

ATTRIBUTES FOR SUCCESS:

  • Ability to utilize professional knowledge, judgement and skills in the application of Policy guidelines
  • Ability to analyze processes and contribute to improvements
  • Comfortable with technology and changes in technology
  • Strong verbal and written communication skills

As a trusted systems integrator for more than 50 years, General Dynamics Information Technology provides information technology (IT), systems engineering, professional services and simulation and training to customers in the defense, federal civilian government, health, homeland security, intelligence, state and local government and commercial sectors. With approximately 32,000 professionals worldwide, the company delivers IT enterprise solutions, manages large-scale, mission-critical IT programs and provides mission support services. 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.

The likely salary range for this position is $51,085 - $85,301, this is not, however, a guarantee of compensation or salary; rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

View information about benefits and our total rewards program.


About Our Work

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.

COVID-19 Vaccination

GDIT does not have a vaccination mandate applicable to all employees. To protect the health and safety of its employees and to comply with customer requirements, however, GDIT may require employees in certain positions to be fully vaccinated against COVID-19. Vaccination requirements will depend on the status of the federal contractor mandate and customer site requirements.

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.