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Medical Policy Consultant

1 month ago

Richmond, United States Elevance Health Full time

Medical Policy Consultant National Government Services is a proud member of Elevance Health Companies, Inc. family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. Location: This is a virtual position, and preferred candidates reside within 50 miles of an Elevance Health PulsePoint location. Shift: Monday - Friday 8 am - 4:30 pm EST. The Medical Policy Consultant is responsible for researching and drafting NGS Medical Policy ensuring the use of valid and consistent research methodologies. How you will make an Impact: Conducts structured research within defined methodologies. Drafts and modifies policies using consistent template tools and criteria. Reviews new and updated codes for accuracy and consistency. Researches relevant studies and review articles for the development of local coverage determinations, coverage articles, and coding guidelines and for responses to inquiries from providers. Finalizes issues and ensures implementation of these policies. Works with other internal areas and with the Medical Directors to respond to internal and external requests that seek written clarification of a general or specific policy question. Attendance and understanding of edits via the Edit Effectiveness meetings is a critical skill. Ability to think on your feet and learn the policy consultant job quickly. Scheduling Open Meetings/CACs and informal meeting processes must be learned. Reviews and responds to OIG, CMS questions, and FOIA requests in a timely fashion. Must be able to formulate a written policy in collaboration with Medical Directors and attend workgroup meetings and weekly CMD/MPU meetings. Minimum Requirements: Requires a BA/BS degree in a related field and a minimum of 2 years related experience; or any combination of education and experience which would provide an equivalent background. Travels to worksite and other locations as necessary. Working knowledge of coding is required. This position is part of our NGS (National Government Services) division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States at least three of the past five years. Preferred Skills, Capabilities, and Experiences: RN license is preferred. Prior medical literature research experience or related experience is preferred. Technical writing experience preferred. Excellent writing and communication skills and attention to detail as well as a love of research. In-depth knowledge of ICD-10, CPT, and HCPCS codes is preferred. Understanding edits/audits in FISS and MCS is preferred. If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. #J-18808-Ljbffr