Remote Medical Policy & Coding Nurse

General Dynamics Corporation; Falls Church, Northern (VA, KY); Hybrid; USD 85,000 - 115,000; Full time

Job summary

General Dynamics Information Technology (GDIT) is seeking a skilled Medical Policy Review Nurse to support the World Trade Center Health Program. You will ensure accurate, clinically-supported coverage determinations and align coding with medical policy and regulatory standards.

Responsibilities include leading CPT/HCPCS/ICD coding evaluations, collaborating with clinical and coding teams, and guiding authorization and coding treatment decisions in a federal healthcare context.

Qualifications

• Registered Nurse with demonstrated experience in medical coding, medical policy, utilization management, claims, reimbursement, or clinical documentation review.
• Associate degree in Nursing required; bachelor's degree preferred.
• Experience with CPT/HCPCS/ICD coding and policy knowledge is essential.

Responsibilities

• 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, CMS NCD/LCDs, medical necessity concepts, and utilization management criteria to develop evidence-based recommendations for coverage, authorization, and coding treatment.

Skills

Clinical Documentation

Documentation Review

Medical Billing and Coding

Medical Coding

Medical Documentation

Education

Associate degree in Nursing

Bachelor's degree preferred

Tools

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

CPC, CCS, CCA, CRC

MB(T2) security clearance

Job description

General Dynamics Information Technology (GDIT) is seeking a skilled Medical Policy Review Nurse to support the World Trade Center Health Program. You will ensure accurate, clinically-supported coverage determinations and align coding with medical policy and regulatory standards.

Responsibilities include leading CPT/HCPCS/ICD coding evaluations, collaborating with clinical and coding teams, and guiding authorization and coding treatment decisions in a federal healthcare context.