Provider Enrollment Specialist II

Clearance Level
None
Category
Healthcare Claims
Location
Raleigh, North Carolina

REQ#: RQ97923

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

General Dynamics Information Technology created 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 Provider Enrollment Specialist II in Raleigh NC to join our team. In this role you will be a change agent by conducting operational audits and verifying that operational procedures are followed correctly for the Provider Enrollment Section.  This section is responsible for enrolling providers for the NC Medicaid Programs.  This involves ensuring that providers are licensed and accredited for the services enrolling to provide and do not have a criminal background.    

RESPONSIBILITIES:

  • Process provider enrollment applications to ensure new and currently enrolled providers are within compliance within NC State regulations.  
  • Validate the qualifications of licensed professionals, organizational members or organizations
  • Render a determination that an organization or entity meets the established qualifications, requirements and/or standards to provide a service or procedure as outlined in the State business rules/desk procedures.
  • Perform and assess the background check through Lexis Nexis, AAR and PPTD.
  • Perform source verification of licensure, certification, endorsements and accreditations through Lexis Nexis or State Licensure Board.
  • Deny providers that do not meet the requirements.
  • Meet performance quality standards on a daily basis.
  • Meet performance quantity standards on a daily basis.
  • QUALIFICATIONS:

    Requires Skills and Experience - 

  • Requires 2 years administrative experience
  • Knowledge of NC Medicaid or Healthcare
  • Working knowledge of NCTracks.
  • Working knowledge of provider enrollment requirements
  • Proficient with Microsoft suite
  • Desired Skills and Experience:

  • Credentialing experience
  • Customer service experience
  • Experience working with fax machines, computer software, and telephone technology
  • Attention to detail
  • ATTRIBUTES FOR SUCCESS:

  • Strong verbal and written communication
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.