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Clinical Policy Advisor

2 months ago

Shelbyville, Kentucky, United States Elevance Health Full time
Position Title:
Clinical Policy Advisor

Job Overview:

The Clinical Policy Advisor plays a crucial role in the formulation and refinement of medical policies within National Government Services, a key member of the Elevance Health Companies, Inc. family. Our organization is dedicated to managing government contracts for Medicare and collaborating with the Centers for Medicare and Medicaid Services to enhance federal health initiatives.

Location: This role is designed to be remote, with a preference for candidates residing within a 50-mile radius of an Elevance Health location.

Work Schedule: Monday - Friday, 8 am - 4:30 pm EST.

Key Responsibilities:
  • Conduct structured research utilizing established methodologies.
  • Draft and revise policies using standardized templates and criteria.
  • Evaluate new and updated codes for precision and consistency.
  • Investigate pertinent studies and review articles to aid in the creation of local coverage determinations, coverage articles, and coding guidelines, as well as to address inquiries from providers.
  • Finalize policy issues and oversee the implementation of these policies.
  • Collaborate with internal teams and Medical Directors to address both internal and external requests for written clarification on policy matters.
  • Participate in Edit Effectiveness meetings to ensure a comprehensive understanding of policy edits.
  • Demonstrate adaptability and a swift learning curve in the policy consultant role.
  • Familiarize with scheduling Open Meetings/CACs and informal meeting processes.
  • Respond promptly to inquiries from OIG, CMS, and FOIA requests.
  • Collaborate with Medical Directors to develop written policies based on extensive research using available tools.
Minimum Qualifications:
  • A BA/BS degree in a relevant field and a minimum of 2 years of related experience, or an equivalent combination of education and experience.
  • Ability to travel to various work sites as needed.
  • Proficient knowledge of coding is essential.
  • This position is part of our NGS division, which requires applicants to have resided in the United States for at least three of the past five years.
Preferred Skills and Experience:
  • RN license is advantageous.
  • Prior experience in medical literature research is preferred.
  • Experience in technical writing is desirable.
  • Exceptional writing and communication skills, with a keen attention to detail and a passion for research.
  • In-depth understanding of ICD-10, CPT, and HCPCS codes is preferred.
  • Familiarity with edits/audits in FISS and MCS is beneficial.
Company Overview:
Elevance Health is committed to enhancing lives and communities while simplifying healthcare. As a Fortune 25 company with a rich history in the healthcare sector, we seek leaders at all levels who are dedicated to making a positive impact on our members and the communities we serve.

Work Environment:
At Elevance Health, we foster a culture that promotes both strategic advancement and personal growth for our associates. Our core values and behaviors are integral to our culture, driving our business outcomes and shared success.

We offer a competitive range of total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs, alongside comprehensive medical, dental, and vision benefits, retirement plans, and wellness initiatives.