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Nurse Careers

At Aetna, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our more than 4,000 nurses are central to turning our member’s health ambitions, big and small, into achievements. Your role will include helping members stay well, manage health conditions, and access the right care at the right time. As you do this, we’ll support you in achieving more in your life and your work.

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Success Profile

What makes a successful nurse? Here are the traits we are looking for:

  • Collaborative
  • Deadline-oriented
  • Organized
  • Problem Solver
  • Results Driven
  • Technology Savvy
  • Adaptable
  • Compassionate
  • Detail Oriented
  • Flexible
  • Good Listener
  • Open Minded
  • Responsible
  • Team Player

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Benefits

  • Health

  • Wellness

  • Financial

  • Paid Time Off & Disability

  • Life Insurance

  • Additional Benefits

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Job Details

Registered Nurse/Health Service Manager

Primary Location: Blue Bell, Pennsylvania
Additional Locations: PA-Blue Bell
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Description:
The ideal candidate will evaluate inpatient facility claims using specific criteria before payment is issued. Candidate will focus on inpatient industry and company reimbursement and coding concepts.

Fundamental Components:
  • Provide policy and coding guidance for initiatives driven by Medical Policy & Program Solutions (MPPS) and Analytics & Behavior Change (ABC)
  • Provide inpatient coding subject matter expertise by identifying coding opportunities in particular those involving DRGs and other inpatient pricing concepts.
  • Identify potential waste and abuse by performing audits of inpatient medical records.
  • Demonstrate the ability to assign accurate ICD-10 medical codes for diagnoses and procedures performed in an inpatient setting.
  • Ability to integrate coding and reimbursement understanding with charge master updates


Background Experience:
  • Registered Nurse is required
  • Inpatient coding certification is preferred
  • Must be familiar with inpatient facility contracting/pricing methodologies and industry coding concepts
  • Demonstrate basic knowledge of health insurance claim processing
  • Good investigation skills are a plus
  • Excellent verbal and written communication skills
  • Comfortable using various databases and computer systems to research and investigate opportunities


Required Skills:
Benefits Management - Maximizing Healthcare Quality, General Business - Consulting for Solutions, General Business - Demonstrating Business and Industry Acumen

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Ensuring Project Discipline

Functional Skills:
Claim - Claims Administration - cost management, Claim - Policies & procedures, Clinical / Medical - Clinical claim review & coding, Clinical / Medical - Hospital administration

Technology Experience:
Operating System - Windows

Education:
Nursing - Registered Nurse (RN)

Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

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

Candidate Privacy Information:
Aetna takes our candidate'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.

Click To Review Our Benefits (PDF)

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