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in Concord, NH
Nurse Educator - Full-time / Part-time
•30 days ago
Hours | Full-time, Part-time |
---|---|
Location | Concord, New Hampshire |
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
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