Healthcare Claims Examiner Dental Hygienist (NC Dental Hygiene license required)
About The Position
GDIT NCMMIS is a claims processing system for the North Carolina Department of Health and Human Services (NC DHHS), supporting North Carolina citizens enrolled in state-administered benefit plans. The program is seeking a Dental Prior Approval Reviewer to evaluate dental prior approval requests for North Carolina Medicaid. This role requires extensive use of computer systems, claims processing applications, and electronic documentation tools to analyze requests, apply Medicaid policy, and ensure accurate and timely determinations in a high-volume, technology-driven environment.
Requirements
- Active North Carolina license as a Registered Dental Hygienist (RDH).
- 5+ years of clinical dental hygiene experience.
- Demonstrated ability to effectively use computers, electronic systems, and digital tools.
- Strong proficiency with Microsoft Office applications (Word, Excel, OneNote) and Microsoft Outlook for documentation, analysis, and communication.
- Extensive experience using Windows-based computer applications and navigating multiple systems simultaneously.
- Experience using NCTracks or similar Medicaid claims processing systems.
- Thorough knowledge of Medicaid dental policy and prior approval processes.
- High level of proficiency in general computer skills, including data entry, electronic record review, system navigation, and use of common software and digital tools required for claims examination.
Nice To Haves
- Ability to work independently in a remote or office-based, technology-dependent environment while meeting service level agreements and individual performance standards.
Responsibilities
- Evaluate dental prior approval requests for North Carolina Medicaid.
- Analyze requests, apply Medicaid policy, and ensure accurate and timely determinations.
- Utilize computer systems, claims processing applications, and electronic documentation tools.
Benefits
- Variety of medical plan options, some with Health Savings Accounts
- Dental plan options
- Vision plan
- 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match
- Full flex work weeks where possible
- Variety of paid time off plans, including vacation, sick and personal time
- 10 paid holidays per year
- Paid parental leave
- Military leave
- Bereavement leave
- Jury duty leave
- Short and long-term disability benefits
- Life insurance
- Accidental death and dismemberment insurance
- Personal accident insurance
- Critical illness insurance
- Business travel and accident insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
