[Remote] Healthcare Claims Examiner (RN Required)

Note: The job is a remote job and is open to candidates in USA. General Dynamics Information Technology and CSRA have united to create the premier provider of high-tech IT solutions to the government IT market. GDIT is currently seeking a Healthcare Claims Examiner to evaluate the appropriateness of beneficiaries' admission to nursing facilities and ensure compliance with medical necessity requirements.


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

Skills

  • Active North Carolina Registered nurse license or Compact license
  • At least 2 years of clinical experience
  • Knowledge of Microsoft Office and Outlook
  • Experience with medical documentation review
  • US Citizenship Required
  • Knowledge of NCTracks
  • Knowledge of business processes of North Carolina Division of Medicaid
  • Clinical medical, surgical and nursing facility experience
  • Clinical research experience

Benefits

  • Medical plan options, some with Health Savings Accounts
  • Dental plan options
  • A vision plan
  • 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
  • Full flex work weeks where possible
  • A variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave
  • 15 days of paid leave per calendar year to be used for vacations, personal business, and illness
  • 10 paid holidays per year
  • 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
  • Short and long-term disability benefits
  • Life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance

Company Overview

  • General Dynamics Information Technology is an IT consulting company that specializes in cyber security, AI, and quantum computing. It is a sub-organization of General Dynamics. It was founded in 1999, and is headquartered in Falls Church, Virginia, USA, with a workforce of 10001+ employees. Its website is https://www.gdit.com/.

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