Job Details

Job Title

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

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: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.