Claims Nurse Reviewer

Clearance Level
None
Category
Healthcare Claims
Location
Raleigh, North Carolina

REQ#: RQ122679

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

We are GDIT. We take pride in providing our clients with the data they need to make important decisions that impact the world around us. 

You make GDIT your place by delivering insights to help our clients make impactful changes real. By owning your opportunity at GDIT, you’ll become a critical part in how we successfully solve our clients’ biggest challenges. Our work depends on a Healthcare Claims Examiner joining our team to support NCMMIS Account activities in Raleigh-Durham, North Carolina.

At GDIT, our people are at the center of everything we do. As a Healthcare Claims Examiner supporting NCMMIS Account. In this role, a typical day will include:

  • Review claims and medical records submitted by providers and make decisions using clinical judgment and state business rules regarding claim payment.
  • Review and adjudication of consent forms.
  • Work with customer to implement changes to business rules, including yearly code updates.
  • Review claim adjustment requests for medical necessity.
  • Maintains nursing license and continuing education
  • Participates in special projects as assigned.

WHAT YOU’LL NEED:

  • BS degree in Nursing from accredited institution of higher-learning.
  • Licensed Registered Nurse license in any state in the U.S. - verified and active.
  • Minimum of 5-years’ experience in nursing care.
  • Working knowledge of all national code sets such as CPT, HCPCS, ICD-10, etc.
  • Knowledge of Medicaid, Public Health, or Mental Health is required.
  • Possesses problem solving skills.
  • Demonstrates excellent active listening, written, verbal communication skills.
  • Demonstrates excellent organizational and time management skills.
  • Responds positively to change, showing willingness to learn new ways to accomplish tasks.
  • Adheres to high standards of personal and professional conduct.
  • NCTracks experience is a plus.

WHAT GDIT CAN OFFER YOU:

  • 401K with company match
  • Challenging work
  • Internal mobility team dedicated to helping you own your career
  • Rewards program for high-performing employees

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.