Dental Consultant

Clearance Level
None
Category
Medical Affairs
Location
Raleigh, North Carolina

REQ#: RQ86919

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

NCTracks was implemented in July 2013 and used by the Division of Health Benefits (DHB); the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS); and the Division of Public Health (DPH). GDIT is the fiscal agent for NC DHHS and handles the daily operations and functionality enhancements to NCTracks.

Providers enrolled in DHB, DMH/DD/SAS and DPH health plans submit claims for payment of covered health care services through the NCTracks Provider Portal. NCTracks coordinates processing among the payers to ensure the proper assignment of the payer, benefit plan and pricing methodology for each service on a claim. NCTracks processes health care claims, prior approval requests, provider enrollment, finance, and other healthcare transactions.

RESPONSIBILITIES: 

Review dental prior approval requests for NC Medicaid and Health Choice recipients utilizing NC DHHS DHB policy to authorize services determined to be medically necessary based on the independent review of dental documentation.

Provide subject matter expert (SME) level support to internal and external customers regarding dental prior approvals. Request additional information or clarification needed to process dental prior authorizations as needed.

Participate as subject matter expert in appeals hearings and mediations.

Assist the NCTracks Dental Director and the Dental Prior Approval team to meet contractual service level requirements.

Supporting Responsibilities: Meet department and account performance, accuracy and attendance expectations. Actively participate in the Dental workgroups or other committees/workgroups as assigned. Consult with the NC DHHS DHB Dental Director or providers when requested. Participate in the establishment and implementation of policies as required.


QUALIFICATIONS:

BS or equivalent + 10 years related experience

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.