GDIT NCMMIS is a claims processing system for the North Carolina Department of Health and Human Services (NC DHHS), supporting North Carolina citizens enrolled in state-administered benefit plans. The program is seeking a Dental Prior Approval Reviewer to evaluate dental prior approval requests for North Carolina Medicaid. This role requires extensive use of computer systems, claims processing applications, and electronic documentation tools to analyze requests, apply Medicaid policy, and ensure accurate and timely determinations in a high-volume, technology-driven environment.
Minimum Requirements:
Requires active North Carolina license as a Registered Dental Hygienist (RDH).
5+ years of clinical dental hygiene experience.
Demonstrated ability to effectively use computers, electronic systems, and digital tools.
The ideal candidate will have:
- Ability to work independently in a remote or office-based, technology-dependent environment while meeting service level agreements and individual performance standards.
- Strong proficiency with Microsoft Office applications (Word, Excel, OneNote) and Microsoft Outlook for documentation, analysis, and communication.
- Extensive experience using Windows-based computer applications and navigating multiple systems simultaneously.
- Experience using NCTracks or similar Medicaid claims processing systems.
- Thorough knowledge of Medicaid dental policy and prior approval processes.
- High level of proficiency in general computer skills, including data entry, electronic record review, system navigation, and use of common software and digital tools required for claims examination.
