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As part of Molina’s response to the COVID-19 pandemic, unless otherwise prohibited by law, new hires with a start date of November 1, 2021 or later will be required to be fully vaccinated.

Senior Specialist, CDI (Remote)

Molina Healthcare United States Job ID 2008464
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Job Description


Job Summary

The Sr. Specialist, Clinical Documentation Improvement is responsible for supporting all activities related to initiatives to accurately capture burden of illness and HEDIS documentation performance

Knowledge/Skills/Abilities

  • Develops and executes implementation and monitoring of local risk adjustment/HEDIS coordination efforts
  • Develops risk adjustment strategy in conjunction with Corporate RQES Department and Provider Services
  • Develops and executes strategy for HEDIS documentation improvement in partnership with National HEDIS team and Plan providers 
  • Consults and collaborates with Health Plans and Risk Adjustment Analytics Reporting to monitor completed provider and member assessments to ensure annual goals are achieved
  • Develop and execute plans to improve Health Plan risk score accuracy
  • Responsible for rollout of risk adjustment initiatives and evaluating success within respective area of responsibility, i.e. Health Plan
  • Ensure coders, providers and nurses are appropriately and accurately documenting matters related to Risk, HEDIS and Pop Health
  • Analyzes reporting, identifies risk and presents to clinical staff and providers to further mitigate risk, including clinical documentation trends, findings, and provide education on the impacts of clinical documentation for both HEDIS and Risk Adjustment
  • Acts as a subject matter expert for providers regarding coding and risk adjustment, responsible for outreach and education for HP Quality and Provider Services on proper coding practices and associated risk. 
  • Responsible for administrative duties related to role/scope, including overseeing the entire risk adjustment process including, but not limited to, tracking, proofing, following through corporate approval process, and any necessary provider follow up

Job Qualifications

REQUIRED EDUCATION:

Associate’s Degree or a combination of equivalent education and experience

REQUIRED EXPERIENCE:

  • 2-4 years experience in Managed Care Programs, preferably Medicaid and Medicare. 
  • 2 years experience working with providers and affecting change and outcomes
  • 2 years of practical application of coding practices
  • Proficient in Microsoft Office, especially Microsoft Excel and PowerPoint
  • Strong communication skills and proficient in presenting to medical professionals
  • Ability to develop feedback and training tools as needed

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

CPC (Certified Professional Coder) or CCS (Certified Coding Specialist)

PREFERRED EDUCATION:

Bachelor’s Degree

PREFERRED EXPERIENCE:

  • Minimum one year experience in supporting risk adjustment activities and improving risk score accuracy and provider education
  • Minimum one year experience in supporting HEDIS abstraction and improving documentation of HEDIS measures

PREFERRED LICENSE/CERTIFICATION

CRC (Certified Risk Coder)

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.

#LI-Remote

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: 05/25/2021

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