Job Overview

An independent subsidiary of WellPoint, Inc, National Government Services (NGS) is one of the largest Medicare contractors in the country, serving nearly 200,000 providers and suppliers and over 20 million customers with Medicare in 20 states and five U.S. territories.
 
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine.

 

Our NGS Nurse Reviewer I is responsible for reviewing and making medical determinations as to whether a claim meets the benefits the member carries.

 

Primary duties may include, but are not limited to:

  • Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.
  • Part B Medical Review workload

 

 

Requires an AS/BS in nursing; 1 year of clinical experience with an understanding of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license required. Ability to comprehend medical policy and criteria to clearly articulate health information required. Previous experience with Medicare claims review especially Part B a plus. Demonstrated ability to use multiple computer programs such as Word, Excel or a claims payment systems a plus.

 

WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.wellpoint.com/careers. EOE. M/F/D/V.