Healthcare Claims Examiner (RN Required)
About The Position
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 War, 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 joining a team of 5 registered nurses who are responsible for ensuring accurate assessment and review of applications for pre-admissions screenings to nursing home facilities.
Requirements
- High school diploma or equivalent
- Requires active North Carolina Registered nurse license with at least 2 years of clinical experience
- Knowledge of Microsoft Office and Outlook
- Experience with claim reviews
Nice To Haves
- Prefer to have knowledge of NCTracks
- Prefer to have knowledge of business processes of North Carolina Division of Medicaid
- Prefer clinical medical and surgical experience
- Prefer clinical research experience
Responsibilities
- Review pre-admission screening resident review (PASRR) applications for beneficiary's seeking admission to nursing facilities.
- Complete the PASRR screening review within 48 hours after the screen has been submitted
- Use clinical nurse knowledge, skills and North Carolina Division of Health and Human services process guide to screen all applicants and residents of Medicaid Certified Nursing facilities with serirous mental illness (MI), Intellectual Developmental Disability (IDD), and conditions related to Intellectual Developmental Disability (RC)
- Verify receipt of documentation that supports PASRR assignment
- Meet daily expected performance goals by completing approximately 35-45 reviews.
- Meet quality expectations of greater than 95% accuracy on quality assurance reviews
- Meet service level agreement of timely adjudication by completing reviews within 2 business days
Benefits
- Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 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.
- To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave.
- To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available.
- We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
