Healthcare Claims Examiner (RN Required)

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

None

Job Family:

Ancillary Health

Job Qualifications:

Skills:

Documentations, Health Care, Microsoft Word, Nursing Fundamentals

Certifications:

None

Experience:

2 + years of related experience

US Citizenship Required:

Yes

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.

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

QUALIFICATIONS:

Required Skills and Experience - 

• 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

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  

ATTRIBUTES FOR SUCCESS:

• 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

The likely salary range for this position is $60,350 - $81,650. 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:

40

Travel Required:

None

Telecommuting Options:

Hybrid

Work Location:

Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

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 off