Medical Policy Review Nurse

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $85k - $115k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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General Dynamics Information Technology

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1954

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

General Dynamics Information Technology is a company at the forefront of technological innovation, offering a wide range of services including consulting, digital modernization, and application services. The company is heavily involved in implementing solutions related to artificial intelligence, cloud computing, cybersecurity, high-performance computing, and quantum technologies. GDIT is committed to supporting government and defense sectors, providing mission-critical services such as logistics and supply chain management, intelligence, and homeland security. The company also focuses on diverse and inclusive hiring practices and actively promotes employee well-being. Through its digital accelerator solutions and pioneering use of emerging technologies, GDIT aims to propel agencies' missions forward and address complex technological challenges.

📋 Description

• Evaluate CPT, HCPCS Level II, ICD-10-CM/PCS, MS-DRG, revenue, and other codes against clinical evidence, benefit language, medical policy, and regulatory guidance • Collaborate with Medical Directors, Utilization Management staff, coding/compliance teams, product teams, and policy analysts • Perform code validations and identify incorrect or inconsistent usage • Recommend prior authorization requirements • Support audits and advise on emerging procedures, technologies, and regulatory changes • Use coding guidelines, clinical literature, CMS NCDs/LCDs, medical necessity concepts, and utilization management criteria • Develop evidence-based recommendations for coverage, authorization, and coding treatment • Support accurate, clinically supported coverage determinations, coding integrity, claims integrity, and federal healthcare mission outcomes

🎯 Requirements

• Associate degree in Nursing required; bachelor’s degree preferred • Registered Nurse with demonstrated experience in medical coding, medical policy, utilization management, claims, reimbursement, or clinical documentation review • 5+ years of related experience • Experience with CPT, HCPCS Level II, ICD-10-CM, ICD-10-PCS, revenue codes, modifiers, Place of Service codes, NCCI edits, medical necessity standards, prior authorization processes, and benefit/coverage concepts • CPC, CCS, CCA, CRC, or equivalent certification preferred • MBI (T2) public trust requirement • Ability to conduct detailed clinical coding reviews • Ability to evaluate medical documentation and research complex clinical/coding subjects • Ability to interpret medical policy and collaborate across clinical, operational, and coding teams • Must have prior supervisory and/or team management experience • Ability to travel less than 10% as needed • US citizenship is not required

🏖️ Benefits

• Comprehensive medical plan options, including plans with Health Savings Accounts • Dental plan options • Vision plan options • 401(k) plan with company match • Full-flex work weeks • Vacation, sick, personal, holiday, paid parental, military, bereavement, and jury duty leave • Typically 15 days of paid leave per calendar year • 10 paid holidays per year • Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees • Short- and long-term disability benefits • Life insurance • Accidental death and dismemberment insurance • Personal accident insurance • Critical illness insurance • Business travel and accident insurance • AI-powered career tool identifying career steps and learning opportunities • Internal mobility team supporting career goals • Award-winning culture of innovation • Military-friendly workplace