[Hiring] Senior Analyst, Pre-Pay Dispute Coding @Molina Healthcare

Role Description

Provides lead level expertise in the resolution of complex provider denial disputes and state complaint cases ensuring the claims adhere to correct billing standards and regulations.

• Investigates and resolves escalated provider denial dispute cases that require advanced experience and specialized knowledge.
• Addresses and resolves state complaint cases related to escalated provider denial disputes.
• Provides assistance to dispute coders by responding to inquiries accurately and in a timely manner.
• Prepares and summarizes trends identified by dispute coders for review by team leadership.
• Investigates and resolves escalated dispute cases that require additional experience and expertise.
• Identifies and communicates any coding errors or inconsistencies, collaborating with appropriate internal department(s) when necessary, capturing and tracking issues to ensure accurate code editing.
• Supports ongoing dispute process improvements and informs leadership of any identified issues.

Qualifications

• Minimum of 4 years of experience in medical coding or billing.
• Active and unrestricted Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification.
• Strong attention to detail and ability to independently read and comprehend the details of medical records.
• Comfortable working in a production-centric environment with high quality standards.
• Ability to use Microsoft Office including Outlook, Word, and Excel.

Requirements

• To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Benefits

• Molina Healthcare offers a competitive benefits and compensation package.
• Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.