Healthcare Claims Examiner Registered Nurse Private Duty Nursing

About the position As a Healthcare Claims Examiner at GDIT, you will play a crucial role in driving better health outcomes for clients by delivering healthcare expertise and services where they are needed most. This position is focused on analyzing prior approval requests for Private Duty Nursing (PDN) services under the North Carolina Medicaid program. You will ensure compliance with organizational and governmental guidelines while working within the GDIT NCMMIS claims processing system, which serves the North Carolina Department of Health and Human Services (NC DHHS). Your contributions will not only impact the lives of North Carolina citizens but also support your personal career growth as you advance in your role as a PDN reviewer. In this position, you will be responsible for processing PDN prior approval requests, ensuring that all work is completed within the required service level agreements (SLAs) and timelines. You will meet quality and quantity benchmarks while collaborating with department leadership, the Medical Director, and the PDN Team. Additionally, you will participate in workgroups that address both clinical and non-clinical internal activities, establishing and maintaining effective working relationships with all levels of staff and clients. Your self-directed approach and positive attitude will be essential as you work with a virtual team that has variable reporting relationships. GDIT offers a full-flex work week, allowing you to balance your priorities at work and at home. With a comprehensive health and wellness package, professional growth opportunities, and cutting-edge technology, you will have the resources needed to succeed in your role. The position also includes paid vacation and holidays, ensuring you have time to rest and recharge. Join GDIT and be part of a global technology and professional services company that is dedicated to creating a safer, smarter world through innovation and expertise. Responsibilities • Process PDN prior approval requests. , • Complete all work within all SLA requirements and timelines. , • Meet all quality and quantity benchmarks. , • Work with department leadership, Medical Director, and PDN Team. , • Participate in workgroups that address both clinical and non-clinical internal activities. Requirements • Current North Carolina Registered Nurse license in good standing. , • 2+ years of clinical PDN experience. , • Medicaid or public healthcare experience is a plus. , • Experience using NCTracks is a plus. Nice-to-haves • Knowledge of Prior Authorization and Claims. , • Experience working with a virtual team with variable reporting relationships. Benefits • 401K with company match , • Comprehensive health and wellness packages , • Paid vacation and holidays , • Paid parental leave , • Short and long-term disability benefits , • Life insurance and accidental death and dismemberment insurance , • Critical illness insurance , • Business travel and accident insurance , • Paid sick and personal time , • Paid military, bereavement, and jury duty leave , • Professional growth opportunities including paid education and certifications Apply Job!