Aetna Health Risk Education Consultant (RN) in Overland Park, Kansas

Req ID: 53257BR

POSITION SUMMARY

Works with internal business partner 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 membership in support of risk adjustment.

Fundamental Components:

  • Uses clinical skills to assess, plan, monitor, and evaluate healthcare services in the provider office setting

  • 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.

  • 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-10 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.

    BACKGROUND/EXPERIENCE desired:

  • RN with current unrestricted state licensure required

  • 3+ years clinical experience is required

  • CPC (Certified Professional Coder) certification or CRC (Certified Risk Adjustment Coder) certification required.

  • Nurses that currently hold the CPC (Certified Professional Coder) certification will be required to obtain the CRC (Certified

    Risk Adjustment Coder) certification within 6 months post hire

  • Nurses that currently hold no coding certification will be required to obtain the CRC (Certified Risk Adjustment Coder) certification within 6 months post hire

  • Experience with Medicare risk adjustment process is required

  • Experience/understanding of electronic medical records/electronic health records in the office setting is required

  • Experience with ICD-10 codes strongly preferred

  • 4+ years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing is preferred

  • Knowledge of regulatory/accreditory guidelines is preferred

  • Knowledge of quality of care and member safety issues is preferred

    EDUCATION

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

    LICENSES AND CERTIFICATIONS

    Nursing/Registered Nurse is required

    FUNCTIONAL EXPERIENCES

    Functional - Nursing//4+ Years

    Functional - Risk Management//1+ Years

    TECHNOLOGY EXPERIENCES

    Technical - Computer Operations//1+ Years/

    Technical - Database//1+ Years/

    ADDITIONAL JOB INFORMATION

  • Position will require regional travel to Aetnas provider offices, clinics, and facilities.

  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

  • Effective communication skills required, both verbal and written.

  • Ability to multi-task, prioritize and effectively adapt to a fast paced changing environment

    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.

    Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care