Analyst Pre-Pay Dispute Coding

Molina Healthcare; Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare provider in Albuquerque seeks a detail-oriented professional to support provider appeals resolutions. The candidate should have at least 2 years of medical coding or billing experience and hold an active CPC or CCS certification. Responsibilities include reviewing claims denials, conducting audits, and communicating determinations to providers. Molina Healthcare offers a competitive hourly pay range of $21.82 - $51.06, depending on experience and skills.

Qualifications

• At least 2 years of experience in medical coding or billing.
• Active and unrestricted CPC or CCS certification.
• Strong ability to read and comprehend medical records.

Responsibilities

• Review coding-related provider claims denials systematically.
• Conduct independent audits of non-medical records.
• Generate and communicate determinations to providers.
• Document and communicate coding errors or inconsistencies.
• Complete data points within internal applications.
• Enhance departmental processes to maintain coding compliance.

Skills

Attention to detail

Medical coding knowledge

Microsoft Office proficiency

Production-centric work capability

Education

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

Job description

Job Description

Job Summary

Provides support through the investigation and resolution of disputes related to provider appeals, ensuring that claims adhere to correct billing standards and regulations.

Job Duties

• Reviews coding-related provider claims denials by systematically examining medical records, denial reasons, submitted claims, and claim history, in accordance with applicable state, federal, and Molina guidelines, rules, and protocols, to determine whether the documentation substantiates the services rendered.
• Conducts independent audits of non-medical records to verify billing accuracy, making decisions within designated authority to either overturn or uphold denials in a timely manner.
• Generates and communicates the determination to the provider using appropriate letter language and providing any necessary guideline links.
• Identifies, documents, and communicates any identified coding errors or inconsistencies, collaborating with appropriate internal department(s) to capture and track issues to ensure precise code editing and compliance.
• Completes data points within internal applications to comply with auditing requirements used within the departments of Molina.
• Actively participates in the enhancement of departmental processes to maintain alignment with current coding regulations and guidelines, while also refining internal procedures.

Job Qualifications

REQUIRED QUALIFICATIONS:

• At least 2 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.

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

Pay Range: $21.82 - $51.06 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.