Provider Enrollment Specialist II

4 weeks ago

Raleigh, United States General Dynamics Information Technology Full time

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Suitability:

No Suitability Required

Public Trust/Other Required:

None

Job Family:

Healthcare Claims

Job Qualifications:

Skills:

Medicaid Programs, Microsoft Office, Operations Processes, Provider Enrollment, State Regulations

Certifications:

Experience:

1 + years of related experience

US Citizenship Required:

No

Job Description:

Healthcare Claims Assistant II

Drive better health outcomes for our clients as a Healthcare Claims Assistant II 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 research, but also your personal career growth. GDIT is currently seeking a Provider Enrollment Specialist II in Raleigh NC to join our team. In this role you will be a change agent by conducting operational audits and verifying that operational procedures are followed correctly for the Provider Enrollment Section. This section is responsible for enrolling providers for the NC Medicaid Programs. This involves ensuring that providers are licensed and accredited for the services enrolling to provide and do not have a criminal background. At GDIT, people are our differentiator. As a Healthcare Claims Assistant II, you will help ensure today is safe and tomorrow is smarter.


RESPONSIBILITIES:

  • Process provider enrollment applications to ensure new and currently enrolled providers are within compliance within NC State regulations.

  • Validate the qualifications of licensed professionals, organizational members or organizations

  • Render a determination that an organization or entity meets the established qualifications, requirements and/or standards to provide a service or procedure as outlined in the State business rules/desk procedures.

  • Perform and assess the background check through Lexis Nexis, AAR and PPTD.

  • Perform source verification of licensure, certification, endorsements and accreditations through Lexis Nexis or State Licensure Board.

  • Deny providers that do not meet the requirements.

  • Meet performance quality standards on a daily basis.

  • Meet performance quantity standards on a daily basis.

QUALIFICATIONS:

  • Requires Skills and Experience

  • Requires 2 years administrative experience

  • Knowledge of NC Medicaid or Healthcare

  • Working knowledge of NCTracks

  • Working knowledge of provider enrollment requirements

  • Proficient with Microsoft suite

Desired Skills and Experience:

  • Credentialing experience

  • Customer service experience

  • Experience working with fax machines, computer software, and telephone technology

  • Attention to detail

ATTRIBUTES FOR SUCCESS:

  • Strong verbal and written communication


HOW A HEALTHCARE CLAIMS ASSISTANT II WILL MAKE AN IMPACT

  • Processes healthcare claims in an accurate and timely manner.


WHAT YOU’LL NEED TO SUCCEED:

  • Education: High School Diploma/GED

  • Required Experience: 1+ years of related experience

  • Security Clearance Level: No

  • Location: Hybrid (In office 1x per week; Raleigh, NC)


GDIT IS YOUR PLACE:

  • Full-flex work week to own your priorities at work and at home

  • 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 holidays

The likely hourly rate for this position is between $16.56 - $21.28. 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 - 2610 Wycliff Rd (NCS010)

Additional Work Locations:

USA NC Raleigh

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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