Molina Healthcare

Senior Specialist, Coding (Remote)

Molina Healthcare$80K — $100K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • 4+ years in medical coding, auditing, or compliance
  • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification
  • Detail-oriented with documentation review skills
  • Ability to collaborate in a complex organization
  • Experience in instructional design and clinical education
  • Effective written and verbal communication skills
  • Proficiency in Microsoft Office and relevant software

Responsibilities

  • Provide senior-level coding expertise and technical oversight
  • Conduct ongoing chart reviews and abstract diagnosis codes
  • Ensure accurate submission of diagnosis codes based on billing practices
  • Document and communicate findings from chart reviews to stakeholders
  • Create educational materials to support risk adjustment for providers
  • Train providers on risk adjustment best practices and coding updates
  • Monitor compliance with CMS guidelines and nurture provider relationships

Benefits

  • Comprehensive benefits package
  • Opportunities for professional development
  • Collaborative and supportive work environment
  • Focus on work-life balance
  • Access to resources for continuous learning
Full Job Description
Job Description

JOB DESCRIPTION

Provides senior level support for coding activities. Responsible for monitoring adherence to Molina's compliance program, minimizing risks related to coding and billing practices, and protecting the business from liability related to fraudulent/abusive practices. Performs chart reviews, facilitates physician education, and maintains comprehensive knowledge of coding rules and regulations.

Essential Job Duties
• Provides senior level coding expertise and administrative technical oversight to ensure successful integration of departmental initiatives.
• Performs ongoing chart reviews and abstracts diagnoses codes in alignment with the Hierarchical Condition Categories (HCC) model.
• Leverages understanding of current billing practices in provider offices to ensure that diagnoses codes are submitted appropriately.
• Documents results/findings from chart reviews, and provides feedback to leadership, providers, and office staff.
• Creates necessary tools (educational materials, newsletters, etc.) for providers to support risk adjustment.
• Provides training and education to network of providers on risk adjustment best practices and provides coding updates related to risk adjustment.
• Monitors progress of providers to ensure guidelines set forth by Centers for Medicare and Medicaid Services (CMS) are adhered to.
• Builds positive relationships between providers, and provides coding assistance as needed.
• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education.
• Collaborates with cross-functional teams to support a variety of projects such as implementation of risk adjustment applications, development of reports, etc.
• Coordinates related activities with departments including finance, revenue analytics, claims, encounters, and medical directors.
• Coordinates CMS data validation activities, including record selection, tracking and submission, in conjunction with coding leadership.
• Maintains professional and technical coding-related knowledge.

Job Requirements
• At least 4 years of medical coding, auditing, and/or compliance experience, or equivalent combination of relevant education and experience.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• Detail-oriented; skilled in medical/clinical documentation review.
• Ability to collaborate in a cross-functional highly matrixed organization.
• Proven experience partnering with business leaders on training design and execution, instructional design, adult learning theory and deploying training through innovative solutions, and ability to strategically approach development and implementation of clinical education across the enterprise.
• Effective verbal and written communication skills, including ability to present to medical professionals.
• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications
• Familiar with the Hierarchical Condition Categories (HCC) risk adjustment model.
• Background in supporting risk adjustment management activities and clinical informatics.

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.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ

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