Healthcare Claims Examiner
About The Position
Solve real-world challenges that impact the frontlines of public health, life science, and clinical research initiatives as a Healthcare Claims Examiner at GDIT. You’ll support the mission and grow with it, building a meaningful career in health. The candidate for this position will be required to perform prior approval reviews under the private duty nursing and the durable medical equipment prior approval review programs. The Division of Health Benefits (DHB) Clinical Coverage Policy is expected to be utilized and referenced in adjudicating the prior approval requests. The candidate will be expected to meet GDIT's service level agreement (SLA) with DHB in each of their assigned areas of review. The average quantity SLA goal is 20-30 reviews each day. The candidate will be expected to meet the quality review expectations on at least 95% of cases reviewed monthly. Clear written denial summaries of resident reviews and additional information request is required. Strong organizational, analytical, decision making and leaderships skills are desired. MEANINGFUL WORK AND PERSONAL IMPACT As a Healthcare Claims Examiner, the work you’ll do at GDIT will be impactful to the mission of our customer. You will play a crucial role in determining the level of services needed for prior approval requests. ● Collaborate with other team members. ● Drive corporate goals. ● Utilize DHB policies and NCTracks system.
Requirements
- Bachelor of Arts/Bachelor of Science or Associate Degree in Nursing
- 2+ years of related experience
- Computer and communication skills
- RN License
- US citizenship required
Nice To Haves
- Strong organizational skills
- Strong analytical skills
- Strong decision-making skills
- Strong leadership skills
Responsibilities
- Perform prior approval reviews under the private duty nursing and the durable medical equipment prior approval review programs.
- Utilize the Division of Health Benefits (DHB) Clinical Coverage Policy in adjudicating prior approval requests.
- Meet GDIT's service level agreement (SLA) with DHB in assigned areas of review (average quantity SLA goal is 20-30 reviews each day).
- Meet quality review expectations on at least 95% of cases reviewed monthly.
- Provide clear written denial summaries of resident reviews and additional information requests.
- Collaborate with other team members.
- Drive corporate goals.
- Utilize DHB policies and NCTracks system.
Benefits
- 401K with company match
- Competitive pay
- Paid time off
- Medical plan options
- Health Savings Accounts
- Dental plan options
- Vision plan
- Full flex work weeks where possible
- Variety of paid time off plans, including vacation, sick and personal time
- Holidays
- Paid parental leave
- Military leave
- Bereavement leave
- Jury duty leave
- Short-term disability benefits
- 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
