SRA International, Inc., A CSRA Company Healthcare Claims Examiner in Raleigh, North Carolina

Clearance Level Must Currently Possess:

No Active Clearance Required

Clearance Level Must Be Able to Obtain:

No Active Clearance Required

Suitability:

No Suitability Required

Job Family:

Administrative Services

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 Defense, the intelligence community and federal civilian agencies as they modernize their information systems.

NCTracks was implemented by CSRA in July 2013 and used by the Division of Medical Assistance (DMA); the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS); and the Division of Public Health (DPH). CSRA is the fiscal agent for NC DHHS and handles the daily operations and functionality enhancements to NCTracks.

Providers enrolled in DMA, DMH/DD/SAS and DPH health plans submit claims for payment of covered health care services through the NCTracks Provider Portal. NCTracks coordinates processing among the payers to ensure the proper assignment of the payer, benefit plan and pricing methodology for each service on a claim. NCTracks processes health care claims, prior approval requests, provider enrollment, finance, and other healthcare transactions.

A licensed nurse is needed as a Healthcare Claims examiner associate to ensure that the team meets the SLA by meeting quantity performance standards of least 35 reviews each day and overall performance expectations:

  • Analyzes durable medical equipment (DME) prior approval requests for NC Medicaid to ensure compliance with clinical guidelines

  • Performs review of documentation submitted prior approval requests for DME services to determine if the recipient is eligible for the services being requested

Required Qualifications:

  • BSN + 3 yrs related experience, or MSN + 1 yr related experience

  • Requires active NC license as Registered Nurse (in good standing)

  • Ability to work independently to meet individual performance standards

  • Must be comfortable with using a computer

  • Knowledge of Microsoft Office and Outlook

  • Prefer to have knowledge of NC Tracks

  • Prefer to have knowledge of business processes of NC DHHS and/or NC Health Choice

  • Prefer experience with DME

# of Openings:

1

Scheduled Weekly Hours:

40

T elecommuting Options:

Some Telecommuting Allowed

Work Location:

USA NC Raleigh - 2610 Wycliff Rd (NCS010)

Additional Work Locations:

CSRA is committed to creating a diverse environment and is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

THINK NEXT. NOW.

CSRA is tomorrow’s thinking, today. To “Think Next. Now.” is to imagine a better future and to deliver it, today. For our customers, our partners, and ultimately, all the people our mission touches, CSRA is realizing the promise of technology to change the world through next-generation thinking and meaningful results.

We understand that our customers' missions require new methods and imaginative thinking. We bring together government IT professionals, emerging technologies, and the brightest, cutting-edge advisors in the industry to deliver a broad range of innovative, next-generation IT solutions and professional services to help our customers modernize their legacy systems, protect their networks and assets, and improve the effectiveness and efficiency of mission-critical functions for our warfighters and our citizens.

Everywhere you look, CSRA is there. We’re in our nation’s infrastructure, in training and education, in cyber security, in serving veterans who served us—and, so much more. Take some time to learn more about CSRA. You might be surprised to learn how we touch your life.

We are a company of 18,000+ smart, talented individuals, yet we enjoy a start-up culture that inspires us to make a difference while delivering results in this rapidly evolving world. Join our team and use your skills and expertise to support the safety, security, health and well-being of the nation.