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Coding Quality Auditor

Primary Location: Cranberry, PA
Additional Locations: FL-Orlando, GA-Atlanta, MO-Kansas City, NC-Charlotte, PA-Blue Bell, PA-Cranberry, PA-Pittsburgh
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Description:
Responsible for performing audits of medical records to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the Risk Adjustment Payment System (RAPS) are appropriate, accurate, and supported by written clinical documentation in accordance with all state and federal regulations and internal policies and procedures.

Fundamental Components:
Performs audits of medical records to ensure all assigned ICD-10 codes are accurate and supported by written clinical documentation. Provides education to internal staff and external providers based on audit findings; provides general education on ICD-10 codes as appropriate. Effectively communicates the audit process and results to the appropriate departments and management. Assists senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy can be achieved. Maintains current knowledge of ICD-10 codes, CMS documentation requirements, and state and federal regulations. Performs other related duties as required.

Background Experience:
  • Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook).
  • Experience with ICD-10 codes required.
  • Experience with Medicare and/or Medicaid Risk Adjustment process required
  • CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required
  • Minimum of 3 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
  • Excellent analytical and problem solving skills
  • Effective communications, organizational, and interpersonal skills.
  • High School Diploma or G.E.D.


Additional Job Information:
Candidate will have experience with Medicare Risk Adjustment and HCC coding. Knowledgeable of ICD-9 and ICD-10 Official Coding Guidelines. Displays ability to function independently and can work cooperatively with other as part of a team. Displays organizational commitment and aligns own behavior with the values, needs and priorities of the company.

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - TE Microsoft Excel

Potential Telework Position:
Yes

Percent of Travel Required:
0 - 10%

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.

Click To Review Our Benefits (PDF)

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