Healthcare Claims Examiner (RN Required)

Public Trust: None

Requisition Type: Regular

Your Impact

Own your opportunity to work alongside federal civilian agencies. Make an impact by providing services that help the government ensure the well being and support of U.S. citizens.

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.

Work Requirements

Years of Experience

2 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

None