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Hours Full-time, Part-time
Location waltham, Massachusetts

About this job

This is a work at home position although you will travel to providers offices to educate them on coding. The ideal candidate will live in Maine, however, we are open to considering anyone in New England that is willing to travel to Maine for work.

POSITION SUMMARY

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.

Fundamental Components:

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. 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-i 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 desired:

Min 4yrs. recent & related experience in medical record documentation review, diagnosis coding and/or auditing CPC or CCS-P required or eligible

Clinical experience is required

Knowledge of regulatory/accreditory guidelines

Knowledge of quality of care and member safety issues

Experience with ICD-9 codes required

Experience with Medicare/Commercial risk adjustment process preferred

Experience of electronic medical records.

EDUCATION

The 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

Coding/Certified Professional Coder (CPC) is preferred

Coding/CCS-P is preferred

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/Clinical claim review & coding/4-6 Years

Functional - Claims/Policies & procedures/4-6 Years

Functional - Medical Management/Medical Management - Coding/4-6 Years

Functional - Products-Medical/All Aetna Standard Plans/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aecclaims East/1-3 Years/Administrator

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/FOUNDATION

Finance/Managing Aetnas Risk/FOUNDATION

DESIRED SKILLS

General Business/Communicating for Impact/FOUNDATION

Leadership/Collaborating for Results/FOUNDATION

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