Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

Performs on-going chart reviews and abstracts diagnosis codes
Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly
Documents results/findings from chart reviews and provides feedback to management, providers, and office staff
Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment
Builds positive relationships between providers and Molina by providing coding assistance when necessary
Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education
Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies
Contributes to team effort by accomplishing related results as needed
Other duties as assigned
2 years previous coding experience
Proficient in Microsoft Office Suite
Ability to effectively interface with staff, clinicians, and management
Excellent verbal and written communication skills
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

Certified Professional Coder (CPC)
Certified Coding Specialist (CCS)

Preferred Education

Bachelor's Degree in related field

Preferred Experience

Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model
Background in supporting risk adjustment management activities and clinical informatics
Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

Certified Risk Adjustment Coder – (CRC)
Certified Professional Payer – Payer (CPC-P)
Certified Coding Specialist – Physician based (CCS-P)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $17.85 - $38.69 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 08/16/2024

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