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Appeals Nurse Consultant

POSITION SUMMARY
Responsible for the review and resolution of clinical claim coding appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical coding criteria and policies in line with regulatory and accreditation requirements for member and provider issues.
Fundamental Components:
Review coding appeals
Prepare coding reviews for Medical Director review
Peer review interaction, Medical Director interaction
Computer skills: Outlook, Excel, Word
BACKGROUND/EXPERIENCE:
Medical Coding experience; preferred
3-5 years of clinical practice experience; required
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
RN (Registered Nurse) (Any State) is required
FUNCTIONAL EXPERIENCES
Functional - Nursing/Clinical claim review and coding/1-3 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Functional - Clinical / Medical/Precertification/1-3 Years
Telework Specifications:
This position is open to candidates all over the US. External Candidates will start in the office closest to their location. Internal Aetna Employees will start out working from home.
ADDITIONAL JOB INFORMATION
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 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.
Employment Type Regular Career Band Description Professional

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