Risk Adjustment Nurse (RN or LPN)

This is a full-time 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.

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