Medical Policy Consultant

Position Title:
Medical Policy Consultant
Job Description:
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.
Locations: Indianapolis, IN, South Portland, ME, Baltimore, MD, Hingham, MA, Syracuse, NY, Cincinnati, OH, Harrisburg, PA, or Denison, TX.
Elevance Health supports a hybrid workplace model with pulse point sites (major offices) used for collaboration, community, and connection. This position can be primarily virtual, however will be based within 50 miles of a pulse point site listed above.
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.
• Review new and updated codes for accuracy and consistency.
• Researches relevant studies and reviews 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. The response may be a reiteration of an established policy a redefinition of the current policy or research to determine a new revised policy.
• 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.
• Review and respond 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. This must be based on significant research using Hayes and other tools available to the policy team.

Minimum Qualifications:

• 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.
• Working knowledge of coding is required.
• This position is part of our FGS (Federal Government Services) division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States for at least three of the past five years.

Preferred Skills, Capabilities, and Experience:

• RN license is preferred.
• Prior medical literature research experience or related experience is preferred.
• Technical writing experience is preferred.
• In-depth knowledge of ICD-10, CPT, and HCPCS codes is preferred.
• Understanding edits/audits in FISS and MCS is preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $61,200 to $110,160.
Locations: New York.
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Exempt
Workshift:
1st Shift (United States of America)
Job Family:
MED >Medical Policy
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World's Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.