Aetna Coding Quality Auditor in Allentown, Pennsylvania

Req ID: 43322BR


Responsible for performing audits of medical records to ensure the ICD-9/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:

Responsible for conducting provider ICD-9/ICD-10 coding audits Responsible for reviewing medical records and validating HCC submissions for internal data validation and CMS National and Target audits. Responsible for ICD-9/ICD-10 coding for Provider Education Program.


Minimum of 2 years recent 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 codes required.

Experience with Medicare and/or Medicaid Risk Adjustment process required


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

Telework Specifications:

This position is full time work from home.


Displays ability to function independently and in a collaborative work environment. Work cooperatively with others as part of 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