JOB DESCRIPTION

Job Summary

Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.

KNOWLEDGE/SKILLS/ABILITIES

• Detects potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns.
• Performs medical record audits in order to validate coding accuracy.
• Performs, as required, non-medical record review audits to validate billing accuracy.
• Generates and provides accurate and timely written reports for internal and/external use detailing audit findings.
• Renders provider coding education as appropriate based on coding guidelines, contractual, and/or regulatory requirements.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

1-3 years

Required License, Certification, Association

Active and unrestricted coding certification (CPC or CCS).

Preferred Education

Bachelor's degree in health care related area.

Preferred Experience

3-5 years

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: $24 - $56.17 / 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.