Healthcare Claims Examiner (RN Required)

General Dynamics Information Technology

6d • $60,350 - $81,650 • Hybrid

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 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.

Requirements

• 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

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, surgical and nursing facility experience
• Prefer clinical research experience

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

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.
• GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year.
• Paid leave and paid holidays are prorated based on the employee’s date of hire.
• The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed