[Hiring] Senior Specialist, Coding @Molina Healthcare

Role 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.

• 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.

Qualifications

• 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.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.