Aetna Health Risk Education Consultant in San Antonio, Texas

Req ID: 39013BR

This will be a work at home position but must live within driving distance to an Aetna office in the San Antonio area. 25%-50% of travel is required around Texas.

POSITION SUMMARY

Works with internal business partner (specifically the Medicare Advantage 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 Medicare Advantage clients in support of risk adjustment. Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.

Fundamental Components:

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 Medicare Advantage 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. Effective communication skills required, both verbal and written.

BACKGROUND/EXPERIENCE desired:

RN w/current unrestricted state licensure req. Certified Professional Coder certification & Certified Risk Adjustment Coder certification req. 2-3 years recent & related experience in medical record documentation review, diagnosis coding & auditing. 3-5 yrs clinical exp. Experience w/ICD-9 codes & risk adjustment process req. Understanding of electronic medical records in office setting req.

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 desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Clinical claim review and coding/2-3 years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Foundation Classes/4-6 Years/End User

ADDITIONAL JOB INFORMATION

Aetna provides a very well designed benefits package for its employees that includes health, vision and dental insurance benefits as well as a 401(k).

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.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Health Care