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Senior Coding Educator

Primary Location: Chicago, Illinois
Additional Locations: IL-Chicago
Helps provider partners ensure quality coding and care management, based on compliance and regulatory guidelines; supports chart chase activities/record retrieval; oversight / connection to national team, responsible for deployment of training; all activities conducted under oversight from certified committee.

Fundamental Components:
• Serves as the training resource and subject matter expert to Providers for questions regarding ICD-10 coding and documentation requirements.
• Provides education to external providers and internal staff based on audit findings; provides general education on ICD-10 codes as appropriate to provider partners.
• Interfaces with providers and Health Plans to resolve disputes regarding appropriate coding and documentation requirements.
• Develops a rapport with providers to act as "best practices" resource on coding practices
• Conducts process chart validation to ensure compliance with existing CMS regulations.
• Responsible for performing audits of medical records to ensure the ICD-10 codes that are submitted to CMS for the Risk Adjustment Payment System (RAPS) are appropriate, accurate, and supported by written clinical documentation in accordance with all state and federal regulations and internal policies and procedures
• Effectively communicates the audit process and results to the appropriate departments and management
• Assists senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy can be achieved
• Maintains current knowledge of ICD-10 codes, CMS documentation requirements, and state and federal regulations
• Performs other duties as required.

Background Experience:
Background/Experience required:
• Minimum of 4 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required
• Experience with ICD-10 codes

Background/Experience desired:
• Experience with Medicare and/or Medicaid Risk Adjustment process
• Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook)
• Effective communications, organizational, and interpersonal skills
• Excellent analytical and problem solving skills

If you hold the CPC (Certified Professional Coder) certification, you will be required to obtain the CRC (Certified Risk Adjustment Coder) certification within 6 months post hire

• Up to 50% travel expected – though most of it should not be overnight.
• Ideal candidate must be self-sufficient, think strategically and display an understanding of how his/her work fits into the overall organizational strategy
• Must be adaptable within often ambiguous scenarios and drive towards success in partnering with Physician offices

Additional Job Information:
For the Finance organization, if you hold the CPC (Certified Professional Coder) certification, you will be required to obtain the CRC (Certified Risk Adjustment Coder) certification within 6 months post hire

Required Skills:
Leadership - Driving a Culture of Compliance, Technology - Leveraging Technology

Desired Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality

Functional Skills:
Medical Management - Medical Management - Coding

Information Technology - Certified Professional Coder (CPC), Medical Management - Certified Coding Specialist-Physicians (CCS-P)

Potential Telework Position:

Percent of Travel Required:
25 - 50%

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

Click To Review Our Benefits (PDF)


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