Coding Quality Auditor

Job Description

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.

67032

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 2 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. Required Skills: General Business - Communicating for Impact, General Business - Ensuring Project Discipline, General Business - Maximizing Work Practices Functional Skills: Clinical / Medical - Clinical claim review & coding, Communication - Communication Quality Control, Medical Management - Medical Management - Coding, Project Management - Time Management, Quality Management - Quality Management Technology Experience: Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Education: Information Technology - Certified Professional Coder (CPC) Potential Telework Position: Yes Percent of Travel Required: 10 - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by 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.