Aetna Coding Quality Auditor in Phoenix, Arizona

Req ID: 54414BR


Responsible for providing non-clinical subject matter expertise to coding related projects and processes at Aetna Medicaid. Aids in maintaining corporate Prior Authorization list and timely updates to all related coding documents. Applies non-clinical coding expertise regarding coverage and authorization requirements.

Fundamental Components:

  • Supports UM Shared Services, Implementation, Claims, Operations and other departments by maintaining and disseminating critical coding-dependent documents including the corporate Prior Authorization grid, benefit grid and related resources; assures updates are accurate and timely

  • Provides support to health plans, contracting and QM around coding for HEDIS, Value Based Purchasing and other initiatives

  • Gathers and prepares data regarding impact of changes in coverage and PA requirements

  • Supports compliance with MH Parity and ACA 1557 requirements

  • Proactively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines

  • Serves as the training resource and subject matter expert to other team members for questions regarding coding and documentation

  • Simultaneously manages multiple, complex projects

  • Provides education to internal staff and external providers based on audit findings; provides general education on ICD-10, HCPCS and CPT codes as appropriate.

  • Maintains current knowledge of ICD-10 HCPCS and CPT codes, CMS documentation requirements, and state and federal regulations.


  • 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

  • Experience with ICD-10 HCPCS and CPT codes required.

  • Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook).

  • Effective communications, organizational, and interpersonal skills.

  • Excellent analytical and problem solving skills


The highest 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


Functional - Medical Management/Medical Management - Coding/1-3 Years


Technical - Desktop Tools/Microsoft Word/1-3 Years/Power User

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/Power User

Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

Telework Specifications:

Considered only for locations in a specific region, state, or city; training period in the office may be required


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 candidates'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

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.