Job Description
Job Summary
Directly responsible and accountable for performing chart reviews, physician education, and maintaining comprehensive knowledge of coding rules and regulations. Provide overall coding expertise as well as administrative and technical oversight to ensure successful integration of Molina initiatives.
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
• Coordinate with Clinical Informatics on system errors and suggest improvements to ensure effective and efficient processes are followed
• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff
• Creates necessary tools (educational materials, newsletters, etc.) for providers to assist them in current and accurate coding practices
• 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
• Monitors progress of providers to ensure Guidelines set forth by CMS (Centers for Medicare and Medicaid Services) are being followed
• 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
• Collaborates with cross-functional team to support a variety of projects such as implementation of risk adjustment applications, development of reports, etc.
• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors
• Assists in coordinating CMS Data Validation activities, including record selection, tracking and submission, in conjunction with the Coding Manager of the RAMP Department
• 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.
Job Qualifications

Required Education
Associates degree or equivalent combination of education and experience
Required Experience
More than 2 years experience in a healthcare setting
More than 2 years experience in coding and medical record chart review
Required License, Certification, Association
Active and unrestricted Coding Certification
Active and unrestricted CCS, CCS-P, or CPC credential
Preferred Education
Bachelor's Degree in Business Administration, Health Care Management or 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
CRC credential

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: $44,936.59 - $97,362.61 / ANNUAL
*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.

Job Type: Full Time Posting Date: 06/27/2024