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Certified Nurse Coder RN (CPC, CCS)

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix, CT-Hartford, MO-Kansas City, NC-Raleigh, NY-New York, OR-Portland, SC-Columbia, TX-Houston
This role is work at home with standard business hours required.
There will be occasional travel required for the role.

Position Summary

Responsible for providing subject matter expertise to all coding-related projects and processes at Aetna Medicaid. Maintains corporate Prior Authorization list and assures timely updates to all related coding documents. Applies clinical and coding expertise to decisions regarding coverage and authorization requirements.

Fundamental Components:
  • Supports UM Shared Services, Implementation, Claims, Operations and other departments by maintaining and disseminating critical coding-dependent documents including the corporate Prior Authorization grid, benefit grid and related resources; assures updates are accurate and timely
  • Provides consultation to health plans, contracting and QM around coding for HEDIS, Value Based Purchasing and other initiatives
  • Gathers and analyzes data regarding impact of changes in coverage and PA requirements
  • Assures compliance with MH Parity and ACA 1557 requirements
  • Commands a comprehensive knowledge of complex delegation arrangements, contracts, clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes (standard)
  • Proactively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines (standard)
  • Serves as the training resource and subject matter expert to other team members for questions regarding coding and documentation
  • Interfaces with providers and health plans when requested to resolve disputes regarding documentation and coding
  • Simultaneously manages multiple, complex projects

Background Experience:
Background/Experience Desired
  • Managed care experience preferred
  • 3+ years of clinical experience required
  • 1+ years of coding experience in a clinical or managed care setting required
  • 3+ years of supervisory experience preferred
  • Experience with Encoder Pro and other coding software preferred
  • Knowledge of Medicare NCD/LCD, MCG, CPBs and other medical necessity criteria preferred
  • Strong ICD-10 and/or DRG knowledge/experience preferred

Education and Certification Requirements
  • RN with current unrestricted state license required
  • Current Coding Certification required: Either AAPC (CPC or CPC-P) or AHIMA (CCS)

Additional Job Information:
Typical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.

Required Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts, Finance - Managing Aetnas Risk, General Business - Demonstrating Business and Industry Acumen, Leadership - Driving a Culture of Compliance

Desired Skills:
General Business - Turning Data into Information, Leadership - Anticipating and Innovating, Leadership - Collaborating for Results, Leadership - Creating Accountability

Functional Skills:
Medical Management - Medical Management - Coding, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Medical Management - Certified Coding Specialist, Nursing - Registered Nurse

Potential Telework Position:

Percent of Travel Required:
0 - 10%

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

Benefit Eligibility:
Benefit eligibility may vary by 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.


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