The scope of the Coder Edit Team includes a comprehensive understanding of medical & dental coding standards. The Coder is responsible for providing information, education, and support to ensure that all Aetna-Medicaid coding is accurate, timely and at the highest levels of integrity. This position provides medical coding support to all departments within Aetna-Medicaid Business Unit, with special emphasis on the following departments: AMA-QMNC, CSRA, Claims, all Health Plans, HPRA, Provider Services and UM-PA
The scope of Claim Check Knowledge Base and Wizard Module administration, integration & maintenance includes and utilizes all coding guidelines. In this position the analyst will use knowledge of coding guidelines (CMS, AMA, Health Plan Policy, Aetna policy), claims processing, edit analysis, financial impact, claims impact, and comprehensive QNXT systems understanding to apply all correct coding polices, Federal regulations, Health Plan policies & Aetna policies to claims as they are processed. This is done by administration, configuration and maintenance of the Claim Check Knowledge Base, Integration Wizard and P.A.M. (policy administration module) Applications.
We are currently in-flight migrating our plans to the more web-based version of this vendor's editing software – ClaimsXten.
• Must be a Certified Coder
• Knowledge of healthcare business application systems is required.
• Experience with core software applications, including Word, Access, Excel, Outlook, PowerPoint, Visio, and Project.
• Excellent understanding of the organization's goals and objectives.
• Understanding of the processing guidelines for all lines of business.
• Understanding of Referral & Service Authorization requirements and logic.
• Maintains a thorough knowledge of standard medical and billing codes utilized including but not limited to Revenue Codes, DRG, CPT, HCPCS, and ICD10 codes. IP/OP coding is a plus.
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
• Ability to Self-Direct.
• Knowledge of medical terminology
• Ability to use independent judgment.
• Excellent written and oral communication skills.
• Excellent listening and interpersonal skills.
• Highly self-motivated and directed.
• Keen attention to detail.
• Proven analytical and creative problem-solving abilities.
• Ability to effectively prioritize and execute tasks in a high-pressure environment.
• Strong customer service orientation.
• Experience working in a team-oriented, collaborative environment.
• Data query and analysis skills
• Ability to provide guidance and training to professional and technical staff in area of expertise.
Certified Coder--C.P.C or C.C.S
High school diploma or equivalent
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Apply on company website