Anthem, Inc. Genetic Counselor Reviewer in Hingham, Massachusetts
SHIFT: Day Job
Your Talent. Our Vision. At AIM Specialty Health (AIM) , a proud member of the Anthem, Inc. family of companies, it’s a powerful combination, and 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.
**$5,000 Sign-On Bonus**
Genetic Counselor Reviewers are responsible for conducting pre-authorization, out of network and appropriateness of genetic tests by utilizing appropriate policies, clinical and department guidelines. They collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of genetic testing to ensure quality member outcomes, and to optimize member benefits. These positions typically require office training, but due to COVID our offices are currently closed. We have approval to offer remote/virtual training and these positions will work full-time remote from home. Location: Work from home Schedule: Monday - Friday, 9:30 am to 6:00 pm PST Internet Requirement: Minimum download speed of 20 megabytes per second (mbps) / upload speed of 5 megabytes per second (mbps)
Primary duties may include, but are not limited to:
• Works closely with Medical directors to review and make recommendations regarding medical necessity of genetic test requests • Receives pre-authorization requests from front-line intake • Conducts initial medical necessity clinical screening • Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review • Conducts initial medical necessity review of out of network pre-authorization requests for services requested outside of the client health plan network • Notifies ordering physician or rendering service provider office of the pre-authorization determination decision • Documents the results of the initial clinical review and determination in the pre-certification computer system • Conducts review of grievance and appeals requests to provide to Medical directors • Maintains confidentiality of patient and provider specific information • Develops telephone service standards to meet departmental performance metrics
Master’s Degree in Genetic Counseling, and/or MS or PhD in Human Genetics, Molecular Biology, or equivalent area of education and expertise from an ACGC accredited program.
Active licensure in the state of residence, if applicable
3+ years of experience in clinical genetics and/or diagnostic laboratory
Experience working in a cross-functional team environment including both technical and non-technical colleagues
Experience in medical review and/or utilization management preferred.
Experience with oncology preferred
Experience, familiarity, and/or willingness to quickly learn reimbursement coding for genomic testing (e.g., CPT, ICD-10-CM) as relevant to testing
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.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
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