RN-Coder Network
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Job Opportunities


Go to www.INDEED.com  use key words for your area such as "ICD-10, remote coding, nurse coder, nurse auditor, CDI, chart review"  and your EMAIL.  You will start receiving updated job postings for your area.  NOTE: Most positions require certification.
RN-Coder Network, Inc. is not an employment agency nor a job placement agency.  From time-to-time, however, other companies will place ads for current positions on our website.  If there are any listings below, please contact the company directly.

CLICK HERE to go to www.RN-Coder.com & sign up for the 27-page report "Companies That Hire Certified RN-Coders"

There are more and more opportunities out there for Certified RN-Coders and Certified RN-Auditors.  Even without ICD10 implementation last year, we have noticed an increase in companies wanting to advertise on AACCA and RN-Coder websites.  Be sure to check this page often for updates.


Risk Adjustment Revenue Nurse (RN or LPN)


This position is a work at home position for candidates that reside in New York and does require 50%-75% local travel. Qualified candidates will hold their RN or LPN license and have at least 3 years of medical record review, diagnosis coding or auditing experience.


POSITION SUMMARY


Work with internal business partners specifically with the CRMO clinical coding team - to develop relationships with local network and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (on and off exchange IVL and SG) in support of risk adjustment. RN or LPN with current unrestricted state licensure required.


 Fundamental Components:


- Traveling on-site to 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.


- Focus of role is to educate providers on how to properly document medical services and interventions received during face to face member encounters.


- This documentation includes proper coding and claim submission for services rendered.


- Will perform audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation.


- 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.


- Shares best practices in risk adjustment across all sites/regions.


- Participates in workgroups to develop learning strategies to improve healthcare delivery performance


- Simultaneously manage multiple, complex projects


 BACKGROUND/EXPERIENCE


- Knowledge of regulatory/accreditory guidelines, quality of care and member safety issues


- Min 4 yrs recent experience in medical record review, diagnosis coding, and/or auditing is required.


-CPC (Certified Professional Coder) or CCS-P (Certified ICD-9 Coding Specialist-Physician) is preferred


- Exp with Medicare and/or Commercial risk adjustment process


- Exp/understanding of elect med & health records


 

EDUCATION


The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.


 

ADDITIONAL JOB INFORMATION


This 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.


 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.


 We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.


 Please apply at https://sjobs.brassring.com/TGWebHost/home.aspx?partnerid=25276&siteid=5012 and use Req # 24968BR


 



Manager of Risk Adjustment (RN or LPN)

This is a work at home position for candidates residing in Southern, CA. Candidates must be comfortable traveling between 25%-50% of the time. Ideally looking for candidates that have 2+ years of supervisory experience as well as a background in coding or medical record review. 

Key Components of the Clinical Risk Manager Position 
• Manager will oversee staff nurses assigned to specific providers who will have direct access and interaction with the physician and office staff. The manager staff monitors access to relevant data; interact with health plan staff and supportive resources. 
• Collaborates with field, internal and provider staff to facilitate member access to care/assessment, adherence to best practices, and coordination of services. 
• Supports relevant member specific risk data for each assigned provider location and ensures targeted identified gaps in care are addressed in a timely and coordinated manner. 
• works collaboratively with the Risk Adjustment, Quality and Network Mgmt. Team to educate and provide feedback to targeted providers. 
• QCC is also a resource for correct risk adjustment diagnostic and procedural coding that meets required standards. In addition, the staff will ensure appropriate, timely submission of related risk adjustment data to the organization. In support of the program to monitor encounter data submission to the organization, QCC staff serves as a liaison and resource for the encounter data analysis analyst. The manager may be a resource to the member and provider by providing the appropriate information to facilitate resolution of issues that arise and to positively impact plan perception and member and provider satisfaction. 

A. Key Job Responsibilities 
i. Monitors provider group assigned involving multiple locations. The following Southern California counties represent the majority of high priority providers: Riverside, San Bernardino, Los Angeles, San Diego & Orange counties. 
ii. Ongoing training and orientation. 
iii. Manager may gradually add other locations depending on the number of members. In order to maximize effectiveness, the maximum number of members/care coordinator should not exceed 2500. 
B. Interfaces with key departments for reporting, technical support, data gathering processes and collection 
C. Discuss and provides advice regarding Risk Reports for assigned Medical Groups and selected physicians and members. 

BACKGROUND/EXPERIENCE 
2+ years of experience in coding or medical record review is required. 
2+ years of managerial or supervisory experience is highly preferred 
Experience in risk management or risk adjustment is preferred 
Experience in a field based role is helpful 
Registered Nurse (RN) or Licensed Practical Nurse (LPN) is required. 

EDUCATION 
The minimum level of education desired for candidates in this position is a GED or High School Diploma. 

Telework Specifications: 
Full-Time Telework (WAH) 

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. 

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Please apply at https://sjobs.brassring.com/TGWebHost/home.aspx?partnerid=25276&siteid=5012 and use                   Req # 25415BR

 ------------

Risk Adjustment Nurse (RN or LPN)

This is a fulltime work at home position and does require up to 25% local travel. Candidates can reside in Southern California or in Washington. Qualified candidates will hold their RN or LPN license and have a minimum of 1 year of medical record review, diagnosis coding or auditing experience. 

POSITION SUMMARY 
Work with internal business partners specifically with the CRMO clinical coding team - to develop relationships with local network and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (on and off exchange IVL and SG) in support of risk adjustment. RN or LPN with current unrestricted state licensure required. 

Fundamental Components: 
- Traveling on-site to 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. 
- Focus of role is to educate providers on how to properly document medical services and interventions received during face to face member encounters. 
- This documentation includes proper coding and claim submission for services rendered. 
- Will perform audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation. 
- 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. 
- Shares best practices in risk adjustment across all sites/regions. 
- Participates in workgroups to develop learning strategies to improve healthcare delivery performance 
- Simultaneously manage multiple, complex projects 

BACKGROUND/EXPERIENCE 
Knowledge of regulatory/accreditory guidelines, quality of care and member safety issues 
Min 1 year recent experience in medical record review, diagnosis coding, and/or auditing is required. 
CPC (Certified Professional Coder) or CCS-P (Certified ICD-9 Coding Specialist-Physician)is preferred 
Exp with Medicare and/or Commercial risk adjustment process 
Exp/understanding of electronic medical & health records 

EDUCATION 
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience. 

ADDITIONAL JOB INFORMATION 
This 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. 

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. 

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Please apply at https://sjobs.brassring.com/TGWebHost/home.aspx?partnerid=25276&siteid=5012 and use                   Req # 25270BR





Good Afternoon Joyce,

 

I spoke with Christina earlier this afternoon and she recommended that I contact you.  We are currently assisting one of our shareholders, Medical Associates in Dubuque, IA with sourcing candidates for a Director of Coding & Reimbursement position.  They have a strong desire to see this individual also have RN credentials as well so, I am reaching out to see if you could assist us with distributing this opportunity throughout the RN Coder membership.  I have attached both the job description as well as some copy we have used when posting the position.

 

It really is a great opportunity with a strong organization and the salary is attractive as well.  The position will lead their coding and reimbursement initiatives as well as related compliance issues.  They will also look to this person to guide them through their preparation and implementation of the ICD-10 transition.  This person will  replace their current Director who is retiring soon from a long and successful tenure.  There are a lot of programs and plans in place to ensure the success of the new individual including ICD-10 preparation and implementation.  They are also fully prepared to offer formal and professional ICD-10 training.

 

Please feel free to share the two attachments I have provided as well as my contact information and let me know if I can assist further with more information.  A posting on your website would be greatly appreciated as well. I am always free for a conversation with you or anyone else regarding details of the role.

 


"Efficiency is getting things done right...Effectiveness is getting the right things done."

 


We are recruiting several full time per diem Nurse Auditors to work remotely from home for a rapidly growing Medical Management company.

 

Title:

Nurse Auditor

 

Job Summary:

Review medical records for accuracy of payment through verification of coding and billing as determined

by clinical information and appropriate guidelines.

 

Key Job Responsibilities:

Duties may include, but not limited to, all or some of the following:

  • Apply medical necessity guidelines based on appropriate criteria
  • Maintain standards set for medical records review.

 

Job Qualifications:

  • Registered Nurse with strong UM background and active licensure in state of practice required.
  • ADN required, BSN preferred.
  • Strong knowledge of Milliman and/or Interqual required.
  • Minimum seven years acute hospital care and/or utilization management experience preferred.
  • Strong knowledge of medical coding (CPT, ICD-9, HCPS) and reimbursement guidelines preferred.
  • Direct experience in medical chart review for inpatient providers preferred.
  • Experience in Medicare and commercial insurance environment preferred.
  • Knowledge of HIPAA laws and requirements preferred.

 

Required Skills:

  • Excellent written (to include report writing) and verbal communication skills.
  • Proficient typist with strong knowledge of computer applications to include Microsoft Office.
  • Ability to multi-task
  • Ability to resolve problems
  • Attention to detail
  • Stress tolerant
  • Sound Nursing judgment skills
  • Self-motivated, with ability to work well independently, as well as with team members.

 

Other:

  • Must have designated area in which to conduct audit reviews in compliance with HIPAA requirements.
  • Ensure maintenance of confidentiality of PHI and/or sensitive information.

 

Interested parties should send resume to:  jeffh@hedquistintl.com

Job Description

Patient Financial Services – Hospital

 

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

 

TITLE:Audit Coordinator - Hospital

 

JOB OVERVIEW:  This position  is responsible for assisting in auditing claims and charges to ensure compliance with all State and Federal guidelines and regulations, coordinating efforts related to payer audits.  The position also includes assisting in appeals of clinical issues on claims and assisting with the review, analysis and resolution of pre-billing claim errors, denied, under-paid, and audited claims.

 

ROLE:  See job description for Administrative Partner for generic job duties.

 

AREA OF ASSIGNMENT: Hospital Patient Financial Services

 

HOURS OF WORK: Exempt professional position

 

RESPONSIBLE TO:Clinical Audit and Appeals Manager


PREREQUISITES:

  1. Current RN State of Washington professional nursing license or Certified Coding Certificate (CRN-C, CPC, CPC-H, CCA, RHIT, CCS) required.
  2. Minimum three years recent clinical, audit or coding experience with a minimum of one year working in an acute care setting.
  3. Demonstrates ability to communicate in writing and verbally in the English language in an effective manner.  Effective communication includes ability to spell accurately and write legibly.
    1. Knowledge of hospital clinical practice standards for health care providers.
    2. Knowledge of ancillary service departments, quality control and safety standards.
    3. General knowledge of criteria sets used to determine eligibility for acute care hospitalization.
    4. General familiarity with medical record coding systems, ICD-9, DRG and CPT coding.
    5. General knowledge of Utilization Review activities and general knowledge of JCAHO, and other regulatory bodies.
    6. Knowledge of third party payer review, reimbursement systems and utilization monitoring requirements for acute care facilities.
      1. Experience with reviewing hospital claims, denials and EOB’s, appealing claims and/or working on claims in an audit is preferred.
      2. Experience with reviewing hospital medical records and codingis preferred.

 

QUALIFICATIONS:

Page 2 – (Audit Coordinator – Hospital)

 

 

UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT, AND WORKING CONDITIONS:See Generic Job Description for Clinical Partner

 

PERFORMANCE RESPONSIBILITIES:

A.  Generic Job Functions: See Generic Job Description for Clinical Partner

 

B.  Unique Job Functions:
     

·         Performand/or assist in all auditing processes, which include review of all clinical areas to ensure accurate charge entry based on documentation of services provided; onsite audits; DRG Audits; Medical necessity Audits; lost charge audits; RAC audits and/or any hospital related audit activities

·         Assist in clinical reviews of patient records to evaluate documentation for accuracy, legibility and completeness as they relate to appropriate assignment of diagnosis, procedure codes and charges.

  • Assist in review and resolution of pre-billing error edits and work with the HIM or other department personnel concerningcharge and/or coding issues.

  • Participate in appeal process for medical necessity or clinical issues when requested.

  • Maintain updated knowledge by review of regulations and coding guidelines through seminars, meetings and materials.

  • Maintain clinical knowledge enhancement.

  • In cooperation with the Director of PFS/Clinical Audit and Appeals Manager/HIM, assist in providing education to Departments and physicians regarding documentation regulations and chart audit findings.

  • Produce activity analysis and statistical reports on a quarterly basis.

  • Prepare productivity and other administrative reports on request.

  • Maintains confidentiality of all protected health information.
    • Demonstrates the awareness of the importance of cost containment for the department.  Provide suggestions regarding process or quality improvement opportunities to department manager.

    • Performs all job functions in a manner consistent with Valley’s cultural expectations defined as Valley Values.   These characteristics include quality performance, demonstrating compassion, respect, teamwork, community-centered awareness and innovation.

    • Other duties as assigned to facilitate accurate, timely patient account management.