JOB DESCRIPTION
Job Summary
Provides senior level support for coding activities. Monitors adherence to Molina's compliance program, minimizing risks related to coding and billing practices, and protecting the business from liability related to fraudulent/abusive practices. Performs chart reviews, facilitates physician education, and maintains comprehensive knowledge of coding rules and regulations.
Essential Job Duties
- Performs ongoing chart reviews and abstracts diagnosis codes.
- Leverages understanding of current provider billing practices to ensure that diagnosis and Current Procedural Terminology (CPT) codes are submitted accurately.
- Coordinates with clinical informatics on system errors and suggests improvements to ensure effective and efficient processes are followed.
- Conducts coding reviews and audits to ensure accuracy and compliance.
- Researches and resolves coding discrepancies.
- Investigates and resolves rejected or denied claims or encounters.
- Maintains proficiency in EMR systems.
- Documents results/findings from chart reviews and provides feedback to leadership, providers, and office staff.
- Creates necessary tools (educational materials, newsletters, etc.) for providers to assist in current and accurate coding practices.
- Provides training and education to network of providers on risk adjustment best practices and provides coding updates related to risk adjustment.
- Monitors progress of providers to ensure guidelines set forth by Centers for Medicare and Medicaid Services (CMS) are adhered to.
- Builds positive relationships between providers and provides coding assistance as needed.
- Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education.
- Collaborates with cross-functional teams to support a variety of projects such as implementation of risk adjustment applications, development of reports, etc.
- Coordinates related activities with departments including finance, revenue analytics, claims, encounters, and medical directors.
- Coordinates CMS data validation activities, including record selection, tracking and submission, in conjunction with coding leadership.
- Maintains professional and technical coding-related knowledge.
- Maintains knowledge of updated coding guidance from recognized medical coding organizations.
- Provides training and support to new and existing coding team members.
Required Job Qualifications
- At least 4 years of medical coding, auditing, and/or compliance experience, or equivalent combination of relevant education and experience.
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
- Detail-oriented skilled in medical/clinical documentation review.
- Ability to collaborate in a cross-functional highly matrixed organization.
- Ability to develop feedback and training tools.
- Ability to present educational materials to relevant groups.
- Effective verbal and written communication skills, including ability to present to medical professionals.
- Microsoft Office suite and applicable software program(s) proficiency.
Preferred Job Qualifications
• Familiar with the Hierarchical Condition Categories (HCC) risk adjustment model.
• Background in supporting risk adjustment management activities and clinical informatics.
To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.
offers a competitive benefits and compensation package. is an Equal Opportunity Employer (EOE) M/F/D/V
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