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Join Our Growing Team! Please note that this exciting Appeals Nurse Consultant role is open to internal Aetna employees across the United States. POSITION SUMMARY As a Registered Nurse (RN) – Appeals Nurse Consultant, you will be responsible for the review and resolution of clinical claim coding appeals and reconsiderations. 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. DRG Reviews also a component of our department reviews. Fulfilling job, learning new concepts, 40 hour work week with no weekends or night coverage!
BACKGROUND/EXPERIENCE desired: • Coding experience preferred. • 2-5+ years of clinical experience desired. • 2-5+ years of computer usage with Microsoft products desired.
Fundamental Components of the Appeals Nurse Consultant position include, but are not limited to: • Review coding appeals/reconsiderations • Prepare coding appeals for Medical Director review • Peer review interaction, Medical Director interaction • Computer skills: Outlook, Excel, Word
EDUCATION The minimum level of education desired for candidates in this position is a Associate’s degree or equivalent experience. LICENSES AND CERTIFICATIONS Active and good-standing Registered Nurse (RN) licensure in state of practice required.
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