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Essential Job Duties
• Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials.
• Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately.
• Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff.
• Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment.
• Builds positive relationships between providers and the business by providing coding assistance as needed.
• Facilitates administrative duties such as planning, chart reviews scheduling, medical records procurement, provider training and education.
• Assists in coordination of management activities with other departments including finance, revenue analytics, claims, encounters and enterprise/plan medical directors.
• Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks and participating in professional societies related to medical coding in the managed care industry.
Required Qualifications• At least 2 years medical coding experience, or equivalent combination of relevant education and experience.
• Certified Professional Coder (CPC).
• Certified Coding Specialist (CCS).
• Latest Centers for Medicare and Medicaid Services (CMS) and American Hospital Association (AHA) clinic coding knowledge.
• Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to effectively interface with staff, clinicians, and management.
• Excellent verbal and written communication skills.
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and all other customers.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
• Certified Risk Adjustment Coder (CRC).
• Certified Professional Payer – Payer (CPC-P).
• Certified Coding Specialist – Physician Based (CCS-P).
• 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.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
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