Healthcare Claims Examiner (RN Required)

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

Confidential

Clearance Level Must Be Able to Obtain:

Confidential

Public Trust/Other Required:

None

Job Family:

Ancillary Health

Job Qualifications:

Skills:

Documentations, Medical Records Management, Nursing

Certifications:

None

Experience:

2 + years of related experience

US Citizenship Required:

No

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 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.

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

QUALIFICATIONS:

Required Skills and Experience - 

• 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

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 and surgical 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

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 $62,900 - $85,100. 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:

USA NC Raleigh

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. 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.

We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 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 capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans