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Aetna Coding Quality Auditor in Cranberry, Pennsylvania

Req ID: 66670BR

Job 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 included but are not limited to:

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.

Qualifications Requirements and Preferences:

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 requiredCPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) requiredMinimum of 2 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.Excellent analytical and problem solving skillsEffective communications, organizational, and interpersonal skills. High School Diploma or G.E.D.

Additional Job Information:

This coding auditor position helps in regulatory audits and other tasks assigned to help the department. Candidate may be asked to work multiple projects or audits. Must be CPC or CCS certified. Experience in risk adjustment preferred.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Quality Management

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.