Aetna Coding Quality Auditor in Overland Park, Kansas

Req ID: 43324BR


Responsible for performing audits of medical records to ensure the ICD-9 and 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 the written clinical documentation in accordance with all state and federal regulations, and internal policies, and procedures.

Fundamental Components:

The successful Coding Quality Auditor: - Performs audits of medical records to ensure all assigned ICD-9 and ICD-10 codes are accurate and supported by clinical documentation (90% + of staff time). - Provides education to internal staff and external providers based on audit findings; provides general education on ICD-9 and 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-9 and ICD-10 codes, CMS documentation requirements, and state and federal regulations. - Performs other duties as assigned.


Minimum of 2 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing. CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required. Must be willing to obtain CRC within 6 months of being hired Experience with ICD- 9 and ICD-10 codes required. Experience with Medicare and/or Medicaid Risk Adjustment process required. Microsoft Office experience required.(specifically outlook and excel)


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/American Academy of Professional Coders is desired


Functional - Clinical / Medical/Clinical claim review & coding/2+ Years


Technical - Desktop Tools/Microsoft Outlook/2+ Years/End User

Technical - Desktop Tools/Microsoft Word/2+ Years/End User

Telework Specifications:

Option for telework(1 day office-based, 4 days telework) will be evaluated upon successful orientation/training period in the office. Candidates living outside of the KC Metro area may be considered for full-time telework. Training period in the office may be required.


The successful candidate displays the ability to function independently and in a collaborative work environment. Works cooperatively with others as a team. Displays organizational commitment; aligns own behavior with the values, needs and priorities of Aetna.

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.

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.

Job Function: Quality Management