Req ID: 34831BR
POSITION SUMMARYWorks with internal business partner (specifically the CRMO clinical coding team), to develop relationships with local networks and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (both on and off exchanges, individual and small group clients) in support of risk adjustmentFundamental Components:Uses clinical skills to assess, plan, monitor and evaluate healthcare services in the provider office setting participating in direct patient care and assessment. - Responsible for educating providers on how to properly document medical services and interventions received during face to face encounters, including proper coding and claim submission for services rendered. - Works on-site in physician offices to assist with scheduling appointments for health risk assessments and other related medical services in support of our commercial exchange members who may have a gap in care. - Serves as a liaison to peers to provide in-depth clinical knowledge and expertise to support the education of providers. - Performs audits of medical records to ensure all assigned ICD-9/10 codes are accurate and supported by written clinical documentation. - Identifies barriers utilizing critical thinking skills to identify improvement opportunities, communicate them to the national team, and help facilitate gains in efficiency and appropriate risk score capture. - Leads work groups to develop learning strategies to improve health care delivery performance. - Serves as the training resource and subject matter expert to regionally aligned network practices. - Identifies and recommends opportunities for process improvements at the practice level to improve overall risk adjustment scores and gaps. - Identifies opportunities to promote quality. - Shares best practices in risk adjustment across all sites/regions. - Simultaneously manages multiple, complex projects.BACKGROUND/EXPERIENCE desired:LPN/LVN with current unrestricted state licensure(Certified Risk Adjustment Coder) certification within 6 months post hirePrevious coding experience preferredPrevious provider office experience preferredEDUCATIONThe highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.LICENSES AND CERTIFICATIONSNursing/Board of Nursing (Any State) is desiredMiscellaneous/Miscellaneous is desiredFUNCTIONAL EXPERIENCESFunctional - Nursing/Clinical claim review and coding/1-3 YearsFunctional - Nursing/Disease management/1-3 YearsFunctional - Clinical / Medical/Direct patient care (hospital, private practice)/TECHNOLOGY EXPERIENCESTechnical - Aetna Applications/SAM Password Reset/1-3 Years/End UserTechnical - Aetna Applications//1-3 Years/End UserTechnical - Remote Access/Broadband VPN/1-3 Years/End UserTelework Specifications:Full time TeleworkADDITIONAL JOB INFORMATIONPosition will require regional travel to Aetnas provider offices, clinics and facilities. - Position requires proficiency with computer skills which include navigating multiple systems and keyboarding. - Effective Communication skills required, both verbal and written. - Ability to multi-task, prioritize and effectively adapt to a fast paced changing environment. - Position is sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer. - Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. - Work is performed in a typical office environment with productivity and quality expectations.Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.Together we will empower people to live healthier lives.Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Health Care