Here's ANOTHER RN-Coder position for you!

Dr. Richard Schamp has announced an RN-Coder position in the Philadelphia-Delaware area.  This is working with one of their PACE contracts, which is similar to the HCC coding (ICD9 only) for the Medicare Advantage Plans.

Capstone Performance Systems is seeking a Professional Remote Medical Coder who will apply his or her technical and specialized expertise to help healthcare programs remain compliant with government regulations while identifying opportunities for increased financial success.

The Professional Medical Coder will work from his or her home office in the St. Louis, MO or Pittsburgh, PA area to review, analyze, and code diagnostic and procedural information from medical records that determine payments to our clients.  The primary function of this position is to perform ICD-9-CM, CPT and HCPCS coding for reimbursement.  The coding function is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.

The successful candidate for this position will:

• Perform medical record reviews and use coding principles to code to the highest specificity and comply with CMS and HIPAA regulations as well as company goals and policies.
• Perform Quantitative and Qualitative analysis of paper and electronic medical records for completeness, consistency and accuracy.
• Perform risk adjustment data validations using AHA coding guidelines.
• Interact with clients and co-workers to communicate value added information, make improvements and maintain strong partnerships.
• Be a constant learner, performing research and staying abreast of updates to remain top in his/her field.

The successful candidate will:

• Possess valid Certified RN-Coder (CRN-C) credential issued by the American Association of Clinical Coders & Auditors, or a Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association; Certified Professional Coder (CPC) designation or Certified Professional Coder Apprentice (CPC-A) designation. 
• Possess at least 6 months experience coding ICD-9 CM.
• Have experience with MS Word, Excel, PowerPoint, and be comfortable learning and becoming an expert on new and proprietary software.
• Have strong written and verbal communication skills, including propensity to establish and build strong relationships.
• Take initiative to establish priorities, coordinate work activities and perform multiple and complex tasks while working independently and with minimal supervision in a remote setting.
• Be detail oriented and quick to follow instructions and learn new tasks.
• Possess a strong work ethic with impeccable integrity.
• Documentation Improvement experience, experience in Hierarchical Condition Categories (HCC), knowledge of or experience in Medicare Advantage plans and knowledge of or experience in managed health care systems, PACE or Medicare are plusses.

Another New RN-Coder Position with Aetna!

Risk Adjustment Revenue Nurse (RN or LPN)

This position is a work at home position for candidates that reside in New York and does require 50%-75% local travel. Qualified candidates will hold their RN or LPN license and have at least 3 years of medical record review, diagnosis coding or auditing experience.

POSITION SUMMARY

Work with internal business partners specifically with the CRMO clinical coding team - to develop relationships with local network and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (on and off exchange IVL and SG) in support of risk adjustment. RN or LPN with current unrestricted state licensure required.

Fundamental Components:

- Traveling on-site to 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.

- Focus of role is to educate providers on how to properly document medical services and interventions received during face to face member encounters.

- This documentation includes proper coding and claim submission for services rendered.

- Will perform audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation.

- 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.

- Shares best practices in risk adjustment across all sites/regions.

- Participates in workgroups to develop learning strategies to improve healthcare delivery performance

- Simultaneously manage multiple, complex projects

BACKGROUND/EXPERIENCE

- Knowledge of regulatory/accreditory guidelines, quality of care and member safety issues

- Min 4 yrs recent experience in medical record review, diagnosis coding, and/or auditing is required.

- CPC (Certified Professional Coder) or CCS-P (Certified ICD-9 Coding Specialist-Physician) is preferred

- Exp with Medicare and/or Commercial risk adjustment process

- Exp/understanding of elect med & health records

EDUCATION

The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.

ADDITIONAL JOB INFORMATION

This position will require regional travel to Aetna's provider offices, clinics, and facilities.

Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

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.

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Please apply athttps://sjobs.brassring.com/TGWebHost/home.aspx?partnerid=25276&siteid=5012and use Req # 24968BR

New Job Postings!

Hello RN-Coders & RN-Auditors!  More excellent work@home positions with large insurer!

There are more and more opportunities out there for Certified RN-Coders and Certified RN-Auditors.  Even without ICD10 implementation last year, we have noticed an increase in companies wanting to advertise on AACCA and RN-Coder websites.  Be sure to check this page often for updates!

Manager of Risk Adjustment (RN or LPN)

This is a work at home position for candidates residing in Southern, CA. Candidates must be comfortable traveling between 25%-50% of the time. Ideally looking for candidates that have 2+ years of supervisory experience as well as a background in coding or medical record review. 

Key Components of the Clinical Risk Manager Position 
• Manager will oversee staff nurses assigned to specific providers who will have direct access and interaction with the physician and office staff. The manager staff monitors access to relevant data; interact with health plan staff and supportive resources. 
• Collaborates with field, internal and provider staff to facilitate member access to care/assessment, adherence to best practices, and coordination of services. 
• Supports relevant member specific risk data for each assigned provider location and ensures targeted identified gaps in care are addressed in a timely and coordinated manner. 
• works collaboratively with the Risk Adjustment, Quality and Network Mgmt. Team to educate and provide feedback to targeted providers. 
• QCC is also a resource for correct risk adjustment diagnostic and procedural coding that meets required standards. In addition, the staff will ensure appropriate, timely submission of related risk adjustment data to the organization. In support of the program to monitor encounter data submission to the organization, QCC staff serves as a liaison and resource for the encounter data analysis analyst. The manager may be a resource to the member and provider by providing the appropriate information to facilitate resolution of issues that arise and to positively impact plan perception and member and provider satisfaction. 

A. Key Job Responsibilities 
i. Monitors provider group assigned involving multiple locations. The following Southern California counties represent the majority of high priority providers: Riverside, San Bernardino, Los Angeles, San Diego & Orange counties. 
ii. Ongoing training and orientation. 
iii. Manager may gradually add other locations depending on the number of members. In order to maximize effectiveness, the maximum number of members/care coordinator should not exceed 2500. 
B. Interfaces with key departments for reporting, technical support, data gathering processes and collection 
C. Discuss and provides advice regarding Risk Reports for assigned Medical Groups and selected physicians and members. 

BACKGROUND/EXPERIENCE 
2+ years of experience in coding or medical record review is required. 
2+ years of managerial or supervisory experience is highly preferred 
Experience in risk management or risk adjustment is preferred 
Experience in a field based role is helpful 
Registered Nurse (RN) or Licensed Practical Nurse (LPN) is required. 

EDUCATION 
The minimum level of education desired for candidates in this position is a GED or High School Diploma. 

Telework Specifications: 
Full-Time Telework (WAH) 

ADDITIONAL JOB INFORMATION 
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. 

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Please apply at https://sjobs.brassring.com/TGWebHost/home.aspx?partnerid=25276&siteid=5012 and use                   Req # 25415BR

 ------------

Risk Adjustment Nurse (RN or LPN)

This is a fulltime work at home position and does require up to 25% local travel. Candidates can reside in Southern California or in Washington. Qualified candidates will hold their RN or LPN license and have a minimum of 1 year of medical record review, diagnosis coding or auditing experience. 

POSITION SUMMARY 
Work with internal business partners specifically with the CRMO clinical coding team - to develop relationships with local network and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (on and off exchange IVL and SG) in support of risk adjustment. RN or LPN with current unrestricted state licensure required. 

Fundamental Components: 
- Traveling on-site to 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. 
- Focus of role is to educate providers on how to properly document medical services and interventions received during face to face member encounters. 
- This documentation includes proper coding and claim submission for services rendered. 
- Will perform audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation. 
- 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. 
- Shares best practices in risk adjustment across all sites/regions. 
- Participates in workgroups to develop learning strategies to improve healthcare delivery performance 
- Simultaneously manage multiple, complex projects 

BACKGROUND/EXPERIENCE 
Knowledge of regulatory/accreditory guidelines, quality of care and member safety issues 
Min 1 year recent experience in medical record review, diagnosis coding, and/or auditing is required. 
CPC (Certified Professional Coder) or CCS-P (Certified ICD-9 Coding Specialist-Physician)is preferred 
Exp with Medicare and/or Commercial risk adjustment process 
Exp/understanding of electronic medical & health records 

EDUCATION 
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience. 

ADDITIONAL JOB INFORMATION 
This position will require regional travel to Aetna's provider offices, clinics, and facilities. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. 

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. 

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Please apply at https://sjobs.brassring.com/TGWebHost/home.aspx?partnerid=25276&siteid=5012 and use                   Req # 25270BR