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)

US Citizenship Required

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