Aetna Medical Review Coordinator in Tampa, Florida

Req ID: 38805BR


RN OR LPN for Clinical Validation Department under Workers Compensation Bill Review. Retrospective medical review base on coding principles.

Fundamental Components:

100% Retrospective Medical Review for Worker's Compensation Bill Review reading automated medical records and the HCFA 1500 in Bill review Platform to determine if the medical records support the bill charge based on National guidelines.


Practical Nurse (LPN) or LVN depending on state requirements or RN with current unrestricted state licensure required.

3+ years clinical experience - required for managing clinical staff (MRT).

In-depth knowledge of medical terminology and ICD-9, ICD-10, CPT-4, and HCPCS coding required.

Previous experience in claims review, workers compensation, case management, utilization review, orthopedics preferred


The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.


Nursing/Nursing License is required

Medical Management/Medical Coding and Billing Certificate is desired


Functional - Nursing/Case Management/4+ Years

Functional - Nursing/Clinical claim review and coding/1+ Years

Functional - Nursing/Disability/1+ Years

Functional - Nursing/Medical-Surgical Care/1+ Years

Functional - Nursing/Occupational/1+ Years


TechnicalExperience/TechnicalFocus/1+ Years/End User


Opportunity to work from home utilizing nursing clinical experience and assessment skills for retrospective medical review.

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.

Job Function: Workers' Compensation