Anthem NGS Medical Policy Consultant, Remote Nationwide (PS7963) in Norfolk, Virginia

NGS Medical Policy Consultant, Remote Nationwide (PS7963)


Location: United States

Field: Medical

Requisition #: PS7963

Post Date: 3 days ago

Your Talent. Our Vision. At National Government Services (NGS) , an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care .

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

This is a uniquely challenging opportunity to develop policy for NGS and work interdepartmentally and with the NGS Medical Directors. Seeking a candidate with a clinical background (R.N.) and that has familiarity with current policies, both LCDs and NCDs. Highly skilled in research surrounding new and/or revised policies.

This Is A Remote Based Position

The Medical Policy Consultant is responsible for researching and drafting NSG Medical Policy ensuring the use of valid and consistent research methodologies.

Primary duties may include but are not limited to:

  • 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 reviews articles for development of local coverage determinations coverage articles and coding guidelines and for responses to inquiries from providers.

  • Works with Medical Directors on development of local coverage determinations.

  • 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 reiteration of an established policy a redefinition of the current policy or research to determine a new or revised policy.

  • Requires a BA/BS in a related field; 2 years of related experience; or any combination of education and experience which would provide an equivalent background.

  • Travel required. Prior medical literature research experience or related experience preferred. Technical writing experience preferred.

  • Working knowledge of coding required.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.