Manager, MRA Coding Quality

Job Description

Description: Performs validation steps in any regulatory audit, such as National RADV, Contract Level RADV
and OIG. Reviews and prepares support for regulatory audits. Collaborates with legal, compliance
and leadership on final submissions. Ensure audits are completed timely and consistent with deadlines.
Monitor trends on coding errors by providers, vendors and Aetna Coders. Provide timely feedback to vendors,
team, peers and leadership. Monitor all Coder IRR. Support Coders and department to meet
and/or exceed 95% accuracy requirement. Professionally perform one on one and roundtable
discussions on coding discrepancies. Hold weekly coding quality discussions with assigned
vendors. Facilitate roundtable discussions with vendors to finalize contractual audits and assign
accuracy rate

65298

Fundamental Components: Makes business decisions based on the results of research and data analysis. Has responsibility for decision making regarding the design, development, and implementation strategy of quality improvement projects, and initiatives. May manage a QM functional department including development and oversight of performance metrics and application of HR policies and procedures. Forms and leads cross functional teams to assist business units in integrating quality into their strategic and operational plans. Evaluates and prioritizes recommendations for quality improvement to senior management and/or customers. Partners with sales and marketing across all segments in their efforts to acquire and retain customers (e.g. responding to RFPs), quality presentations, request for measurement information. Develops and implements the infrastructure of the QM program and Patient Safety strategy. Develops, implements, and evaluates the organization’s policies and procedures to meet business needs. Directs/provides enhancements to business processes, policies and infrastructure to improve operational efficiency across the organization. Influences department business owners and leaders to reach solutions to meet the needs of Plan Sponsors, regulators and other customers while meeting departmental objectives. Performs strategic analysis of business performance data to address Plan Sponsor needs. In partnership with business owners, supports design /development of new or enhanced products and services. Translates knowledge of subject and business needs into clear strategic business plans. Serves as a technical, professional and/or business expert that may cross multiple business functions. Background Experience:
6+ years progressive experience in operational coding management in the healthcare industry, regulatory environment and quality management.
Medicare risk coding experience required
Demonstrated leadership ability.
EDUCATION
Bachelor's degree, or equivalent healthcare experience.
CERTIFICATION
CPC (Certified Professional Coder) certification will be required
THEN, Employee that currently hold coding certification will be required to obtain the CRC (Certified Risk Adjustment Coder) certification within 6 months post hire. Additional Job Information: Lead team in managing coding projects and
assignments to achieve clear goals and measurable outcomes. Provide guidance and oversite so
that all projects can successfully meet designated timelines, production standards and quality
expectations of deliverables. Works with management on analytics and strategy for project
success. Daily monitoring of status of project to enable timely feedback to leadership. Identify
areas of opportunity and improvement. Support and manage change including the ability to
change course midstream to ensure success. Coach and support direct reports to ensure
performance goals are met. Communicate effectively with team and peers Required Skills: Leadership - Collaborating for Results, Leadership - Creating Accountability, Leadership - Driving Change Desired Skills: General Business - Communicating for Impact, Leadership - Collaborating for Results, Leadership - Developing and Executing Strategy, Leadership - Engaging and Developing People Functional Skills: Clinical / Medical - Management: < 25 employees, Clinical / Medical - Quality management Technology Experience: Database - Microsoft Access, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Education: Information Technology - Certified Professional Coder (CPC) Potential Telework Position: Yes Percent of Travel Required: 25 - 50% 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.