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
