Job Description

Public Trust: MBI (T2)

Requisition Type: Regular

Your Impact

Own your opportunity to be on the frontlines of health innovation. Deliver for America’s health agency missions and enhance lives for hundreds of millions every day.

Job Description

The World Trade Center Health Program is a limited federal health program administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services (HHS). The Program provides no-cost medical monitoring and treatment for certified WTC-related health conditions to those directly affected by the 9/11 attacks in New York, the Pentagon, and in Shanksville, Pennsylvania

The Medical Policy Review Nurse will contribute to the strategic direction of the business and support impactful mission outcomes as an Medical Policy Review Nurse at GDIT. Here, you’ll enable the success of one of the most critical federal healthcare missions and ensure accurate, clinically‑supported coverage determinations for the World Trade Center Health Program.   This position will be impactful to the mission of the World Trade Center Health Program (WTCHP) . You will play a crucial role in bridging clinical judgment and coding accuracy to ensure coverage, authorization requirements, and claims integrity align with clinical documentation, medical policy, coding standards, and federal regulatory requirements.

MEANINGFUL WORK AND PERSONAL IMPACT

● Lead the evaluation of CPT, HCPCS Level II, ICD‑10‑CM/PCS, MS‑DRG, revenue, and other codes against clinical evidence, benefit language, medical policy, and regulatory guidance to support coverage determinations.
● Collaborate with Medical Directors, Utilization Management staff, coding/compliance teams, product teams, and policy analysts to ensure coding and coverage logic remain clinically appropriate, operationally feasible, and compliant.
● Drive high‑quality clinical and coding outcomes by performing code validations, identifying incorrect or inconsistent usage, recommending prior authorization requirements, supporting audits, and advising on emerging procedures, technologies, and regulatory changes.
● Utilize coding guidelines, clinical literature, CMS NCD/LCDs, medical necessity concepts, and utilization management criteria to develop evidence‑based recommendations for coverage, authorization, and coding treatment.

WHAT YOU’LL NEED TO SUCCEED

● Education: Associate degree in Nursing required; bachelor’s degree preferred
● Experience: Registered Nurse with demonstrated experience in medical coding, medical policy, utilization management, claims, reimbursement, or clinical documentation review

● Certifications: CPC, CCS, CCA, CRC, or equivalent preferred

● Security clearance level: MB(T2)
● Role requirements: Ability to conduct detailed clinical coding reviews, evaluate medical documentation, research complex clinical/coding subjects, interpret medical policy, and collaborate across clinical, operational, and coding teams; <10% travel as needed

● Must have prior supervisory and/or team management experience

● Technical skills:

• 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

• Benefit/coverage concepts
  

GDIT IS YOUR PLACE

● Growth: AI-powered career tool that identifies career steps and learning opportunities
● Support: An internal mobility team focused on helping you achieve your career goals
● Rewards: Comprehensive benefits and wellness packages, 401K with company match, competitive pay, and paid time off
● Flexibility: Full-flex work week to own your priorities at work and at home
● Community: Award-winning culture of innovation and a military-friendly workplace

OWN YOUR OPPORTUNITY

Explore a career at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your passion for advancing clinical accuracy, coding integrity, and mission‑critical healthcare delivery.

#GDITFedHealthJobs

#WTCJobs

Work Requirements

Years of Experience

5 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

Less than 10%

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