Healthcare Claims Examiner Sr. - Dental and Orthodontic Medicaid Appeals

Company: General Dynamics Information Technology
Location: Raleigh
Posted on: February 11, 2025

Job Description:

Type of Requisition:RegularClearance Level Must Currently Possess:NoneClearance Level Must Be Able to Obtain:NonePublic Trust/Other Required:NoneJob Family:Healthcare ClaimsJob Qualifications:Skills:Dental Hygiene, Medicaid, Microsoft Office, Orthodontics, Strong verbal and personal communication skillsCertifications:NoneExperience:5 + years of related experienceUS Citizenship Required:NoJob Description:Healthcare Claims Examiner Senior - Dental and Orthodontic Medicaid AppealsDrive better health outcomes for our clients as a Healthcare Claims Examiner Senior at GDIT. Here, your work will impact many as you deliver healthcare expertise and services where they are needed most. Own this opportunity to advance not just delivery of needed dental and orthodontic services, but also your personal career growth.At GDIT, people are our differentiator. As a Healthcare Claims Examiner Senior you will help ensure today is safe and tomorrow is smarter. Our work depends on Healthcare Claims Examiner Senior joining our team to ensure North Carolina's Medicaid recipients are receiving the services they are entitled to receive.HOW A HEALTHCARE CLAIMS EXAMINER SENIOR WILL MAKE AN IMPACT

• Perform dental and orthodontic mediations for appealed prior authorizations on behalf of the client.
• Complete all work within all SLA requirements and timelines.
• Meet all quality and quantity benchmarks.
• Work with department leadership, Dental Director, and Orthodontic Consultant to develop process improvements and ensure cases a prepared accordingly.
• Participate in workgroups that address both clinical and non-clinical internal activities.WHAT YOU'LL NEED TO SUCCEED:Qualifications:
  • Current North Carolina Dental Hygiene license in good standing.
  • 5+ years of clinical dental hygiene experience.
  • Working knowledge of Medicaid dental and orthodontic prior approval policies is a plus.
  • Experience using NCTracks is a plus.Skills:
    • Knowledge of Medicaid Prior Authorization and Claims.
    • Excellent communication skills - verbal and written.
    • Establish and maintain effective working relationships with all levels of staff, other business segments, and clients.
    • Self-directed with a positive attitude.
    • Experience working with a virtual team with variable reporting relationships.
    • Skilled with Microsoft (Word, Excel, Power Point, Outlook, Share Point, & Teams), Zoom, and other web-based applications.Other:
      • This position is currently a hybrid position with the majority of time working remotely.
      • US Citizenship Required.
        GDIT IS YOUR PLACE:--- 401K with company match--- Comprehensive health and wellness packages--- Internal mobility team dedicated to helping you own your career--- Professional growth opportunities including paid education and certifications--- Cutting-edge technology you can learn from--- Rest and recharge with paid vacation and holidaysThe likely salary range for this position is $68,705 - $92,953. 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:40Travel Required:NoneTelecommuting Options:HybridWork Location:USA NC RaleighAdditional 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 30 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.We connect people with the most impactful client missions, creating an unparalleled work experience that allows them to see their impact every day. We create opportunities for our people to lead and learn simultaneously. From securing our nation's most sensitive systems, to enabling digital transformation and cloud adoption, our people are the ones who make change real.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.

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