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Health Risk Educator Consultant

Primary Location: New Albany, OH
Additional Locations: OH-New Albany
Works with internal business partner (specifically the CRMO clinical coding team) in conjunction with Chief Medicare Officer, Director of Operations, Local Network, Health Care Management and Value Based Contracting teams to educate, train, and provide face to face support to physician practice groups who serve our Medicare membership in support of risk adjustment accurate coding.

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 commercial exchange 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-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/sub-markets. Simultaneously manages multiple, complex projects.

Background Experience:
Minimum of 4 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
Experience with ICD-10 codes required.
RN with current unrestricted state licensure required.
Experience/understanding of electronic medical records/electronic health records in the office setting required.
Experience with Medicare and/or Commercial risk adjustment process required.
Nurses that currently hold no coding certification will be required to obtain the CRC (Certified Risk Adjustment Coder) certification within 6 months post hire.
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
CPC (Certified Professional Coder) certification or CRC (Certified Risk Adjustment Coder) certification required.
Knowledge of quality of care and member safety issues
Knowledge of regulatory/accreditory guidelines
3-5 years clinical experience.
Bachelor’s degree or equivalent recent and related work experience.

Additional Job Information:
Position will require regional travel to Aetna’s 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 Position is sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Work is performed in a typical office environment with productivity and quality expectations.

Required Skills:
General Business - Ensuring Project Discipline, Leadership - Collaborating for Results, Technology - Leveraging Technology

Desired Skills:
Benefits Management - Promoting Health Information Technology, General Business - Communicating for Impact, Leadership - Developing and Executing Strategy

Functional Skills:
Clinical / Medical - Clinical claim review & coding, Clinical / Medical - Quality management

Nursing - Registered Nurse

Potential Telework Position:

Percent of Travel Required:
50 - 75%

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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