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Senior Coding Quality Auditor - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Atlanta, Georgia |
About this job
POSITION SUMMARY
Develops and maintains physician office relationships to ensure access and open lines of communication. Reviews medical records for primary care and specialty providers to ensure diagnosis are documented and coded correctly. Ensures compliance with all state and federal regulations.
Fundamental Components:
Responsible for conducting clinical chart reviews for the purpose of identifying and submitting accurate documented diagnoses for members. May facilitate the execution of quality improvement processes for members.
Interacts with a variety of internal and external clients including health care executives, physicians, provider office personnel, and hospital staff.
Performs chart reviews to identify, collect, and compile Healthcare Effectiveness Data and Information Set (HEDIS) results data for quality initiatives.
Interfaces with primary care and specialty physicians to assist with Medicare Risk Adjustment scoring.
Follows assigned members to assure diagnosis coding maintains accuracy. Determines if referrals to case management require further review.
Records findings in database completely and accurately in accordance with standard policies and procedures.
Provides education for the physician and office staff to ensure procedures, diagnosis codes, and medical conditions are coded properly.
Maintains medical/case record standards as appropriate.
May be required to travel to provider offices on a frequent basis.
BACKGROUND/EXPERIENCE desired:
Previous (3-5 years) experience including medical record documentation review and coding experience required
RN or LPN is desired
In-depth knowledge of medical terminology and ICD-9, CPT-4, and HCPCS coding required
Medical coding certification highly desired
Effective communications, organizational, and interpersonal skills
Active drivers license and insurance coverage in the state where job duties are performed
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Licensed Practical Nurse (LPN) is desired/certification in Medical coding is desired
Nursing/Registered Nurse (RN) is desired
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Clinical claim review & coding/1-3 Years
Functional - Nursing/Clinical claim review and coding/1-3 Years
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.
Employment Type Regular Career Band Description Professional
Develops and maintains physician office relationships to ensure access and open lines of communication. Reviews medical records for primary care and specialty providers to ensure diagnosis are documented and coded correctly. Ensures compliance with all state and federal regulations.
Fundamental Components:
Responsible for conducting clinical chart reviews for the purpose of identifying and submitting accurate documented diagnoses for members. May facilitate the execution of quality improvement processes for members.
Interacts with a variety of internal and external clients including health care executives, physicians, provider office personnel, and hospital staff.
Performs chart reviews to identify, collect, and compile Healthcare Effectiveness Data and Information Set (HEDIS) results data for quality initiatives.
Interfaces with primary care and specialty physicians to assist with Medicare Risk Adjustment scoring.
Follows assigned members to assure diagnosis coding maintains accuracy. Determines if referrals to case management require further review.
Records findings in database completely and accurately in accordance with standard policies and procedures.
Provides education for the physician and office staff to ensure procedures, diagnosis codes, and medical conditions are coded properly.
Maintains medical/case record standards as appropriate.
May be required to travel to provider offices on a frequent basis.
BACKGROUND/EXPERIENCE desired:
Previous (3-5 years) experience including medical record documentation review and coding experience required
RN or LPN is desired
In-depth knowledge of medical terminology and ICD-9, CPT-4, and HCPCS coding required
Medical coding certification highly desired
Effective communications, organizational, and interpersonal skills
Active drivers license and insurance coverage in the state where job duties are performed
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Licensed Practical Nurse (LPN) is desired/certification in Medical coding is desired
Nursing/Registered Nurse (RN) is desired
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Clinical claim review & coding/1-3 Years
Functional - Nursing/Clinical claim review and coding/1-3 Years
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.
Employment Type Regular Career Band Description Professional