JOB DESCRIPTION

Job Summary

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.