Healthcare Claims Examiner (RN Required)

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