28813BR
This is an in office position in New York City. There is 50-75% of travel to medical practices within metro New York, and occasionally boroughs and some rural areas.
An RN license is required. Experience with clinical claim review and coding is required.
POSITION SUMMARY
Works with internal business partner (specifically 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 (both on and off exchanges, individual and small group clients) in support of risk adjustment.
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 member 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 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
-RN with current unrestricted state licensure required.
-CPC certification or CRC certification required. Nurses that currently hold the CPC certification will be required to obtain the CRC certification within 6 months post hire. Nurses that currently hold no coding certification will be required to obtain the CRC certification within 6 months post hire.
-3-5 years clinical experience required.
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
ADDITIONAL JOB INFORMATION
You want to work where you can learn, grow and test yourself. And, of course, you want decent, competitive pay and benefits. You've come to the right place. Our salaries and benefits are market-competitive, with bonuses for high achievers. And our benefits come with lots of choices. All are aimed at helping you achieve health and financial well-being. Our employees health and financial well-being are important to us. As of April 2015, we increased our U.S. minimum base wage to $16 per hour, for both hourly and salaried employees. And effective in 2016, eligible Aetna employees can qualify for an enhanced medical benefits program that could save some families thousands of dollars.
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.
An RN license is required. Experience with clinical claim review and coding is required.
POSITION SUMMARY
Works with internal business partner (specifically 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 (both on and off exchanges, individual and small group clients) in support of risk adjustment.
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 member 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 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
-RN with current unrestricted state licensure required.
-CPC certification or CRC certification required. Nurses that currently hold the CPC certification will be required to obtain the CRC certification within 6 months post hire. Nurses that currently hold no coding certification will be required to obtain the CRC certification within 6 months post hire.
-3-5 years clinical experience required.
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
ADDITIONAL JOB INFORMATION
You want to work where you can learn, grow and test yourself. And, of course, you want decent, competitive pay and benefits. You've come to the right place. Our salaries and benefits are market-competitive, with bonuses for high achievers. And our benefits come with lots of choices. All are aimed at helping you achieve health and financial well-being. Our employees health and financial well-being are important to us. As of April 2015, we increased our U.S. minimum base wage to $16 per hour, for both hourly and salaried employees. And effective in 2016, eligible Aetna employees can qualify for an enhanced medical benefits program that could save some families thousands of dollars.
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.
