Aetna Sr Coding Quality Auditor in Arlington, Texas

Req ID: 38938BR


Work with Commercial Risk Management Operations (CRMO) to complete quality review of medical charts and associated coding in support of commercial risk adjustment for the health exchange population (IVL and SG business).

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 vendors based on audit findings; provides general education on coding and documentation requirements for ICD-10 codes as appropriate. Candidate serves as a training resource and subject matter expert to other team members for questions regarding ICD-10 coding and documentation requirements.Effectively communicates the audit process and results to the appropriate departments and management. Interfaces with vendors to resolve disputes regarding appropriate coding and prepares educational materials. Conducts process audits to ensure compliance with internal policies and procedures and existing CMS regulations; identifies and recommends opportunities for process improvements so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy is achieved. Remain current on ICD-10 coding, CMS documentation requirements, and State and Federal regulations.Serve as a liaison between the clinical coding team and the embedded nurse team to align employee and provider education. To ensure consistency of coding practices and guidelines between the coding and embedded nurse team. Provide ICD-10 code set training to embedded nurses for both onboarding and continued education. Assist with RADV reviews and processes as needed. Performs other related duties as required.

BACKGROUND/EXPERIENCE DESIRED Minimum of 4 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.2 years minimum of medical chart review experience is required. One of the following is required: CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician). CRC certification is a plus. 2 years minimum of experience with ICD- codes required. Experience with Medicare and/or Medicaid Risk Adjustment process required.Experience with Microsoft Office products (Word, Excel, Project, PPT)


The minimum level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.


Medical Management/Certified Coding Specialist is desired

Medical Management/Certified Coding Specialist-Physicians (CCS-P) is desired


Functional - Clinical / Medical/Clinical claim review & coding/4+ Years

Telework Specifications:

Part time telework


This is an excellent opportunity for the right candidate in a growing department where a skilled clinical coder can utilize their ICD-10 coding experience, candidate must hold CPC through AAPC or equivalent designation. CRC (Certified Risk Adjustment Coder) certification a plus.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Quality Management