8d ago

Nurse Healthcare Claims Examiner (RN Required)

Any LocationRemotemid

OtherClaims Examiner

1 views0 saves0 applied

Apply Now

Quick Summary

Requirements Summary

Skills:Clinical Research, Health Care, Long Term Care (LTC), Medical Surgical Care,

Technical Tools

OtherClaims Examiner

Regular

Clearance Level Must Currently Possess:

Confidential

Clearance Level Must Be Able to Obtain:

Confidential

None

Job Family:

Ancillary Health

Requirements

~1 min read

Required Skills and Experience -

Requires active North Carolina Registered nurse license or Compact license with at least 2 years of clinical experience in long term care and medical/surgical care
Knowledge of Microsoft Office and Outlook
Experience with medical documentation and reviews

3-5 Years of work experience

Desired Skills and Experience:

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

Clinical Research, Health Care, Long Term Care (LTC), Medical Surgical Care, Surgeries

None

3 + years of related experience

Job Description:

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; evaluating the medical necessity of surgical and medical prior approval request, which may include transplants, out-of-state evaluations and surgeries. .

Responsibilities

~1 min read

→Verify receipt of documentation that supports the medical necessity of prior approval requests for admission into a long term care facility
→Evaluate accuracy and timeliness of documentation submitted for prior approval requests for surgeries and medical care
→Meet daily expected performance expectations by completing at least 30 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 -72 hours
→Meet timely updating of the system with prior approval decisions within 7 business days.
→

Ability to utilize professional knowledge, judgement and skills in the application of Policy guidelines
Ability to analyze processes and contribute to improvements
Comfortable with technology and changes in technology
Strong verbal and written communication skills

As a trusted systems integrator for more than 50 years, General Dynamics Information Technology provides information technology (IT), systems engineering, professional services and simulation and training to customers in the defense, federal civilian government, health, homeland security, intelligence, state and local government and commercial sectors. With approximately 32,000 professionals worldwide, the company delivers IT enterprise solutions, manages large-scale, mission-critical IT programs and provides mission support services. 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.

The likely salary range for this position is $63,118 - $85,394. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

None

Hybrid

Work Location:

Any Location / Remote

Additional Work Locations:

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.

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.

Join our Talent Community to stay up to date on our career opportunities and events at

gdit.com/tc.

Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans