Analyst, Pre-Pay Dispute Coding - Remote must have CPC or CCS

Molina Healthcare; Northern (KY); Hybrid; USD 28,000 - 59,000; Full time

Job summary

Molina Healthcare is seeking a detail-oriented provider denial coding specialist to support the denial coding dispute process. You will review medical records, denial reasons, and claims history to determine whether documentation substantiates services billed.

In this production-focused role, you will conduct audits, decide to overturn or uphold denials, and communicate determinations to providers with guideline links. Proficiency in Microsoft Office and strong communication are required.

Qualifications

• Minimum 2 years in medical coding or billing.
• CPC or CCS certification.
• Detail-oriented with ability to read medical records.
• Able to work in a production-focused environment.
• Strong cross-functional collaboration skills.
• Effective verbal and written communication.
• Proficient in Microsoft Office and related software.

Responsibilities

• Review provider denials by examining medical records and claims to determine documentation sufficiency.
• Audit non-medical records for billing accuracy and decide to overturn or uphold denials.
• Generate and communicate determinations to providers with guideline links.
• Identify coding errors and collaborate to capture and track issues.
• Complete data points in internal applications to meet audit requirements.
• Help enhance departmental processes to stay aligned with coding regulations.

Skills

Coding experience

CPC/CCS

Attention to detail

Production environment

Cross-functional

Communication skills

MS Office

Tools

Microsoft Office

Job description

Provides support for provider denial coding dispute activities. Investigates and resolves disputes related to provider appeals, and ensures that claims adhere to correct billing standards and regulations.

Essential 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; makes decisions within designated authority to either overturn or uphold denials in a timely manner.
• Generates and communicates determination to the provider using appropriate letter language and provides necessary guideline links.
• Identifies, documents, and communicates any identified coding errors or inconsistencies; collaborates with appropriate internal departments to capture and track issues, and ensure precise code editing and compliance.
• Completes data points within internal applications to comply with departmental auditing requirements.
• Actively participates in the enhancement of departmental processes to maintain alignment with current coding regulations and guidelines, while also refining internal procedures.

Required Qualifications

• At least 2 years of experience in medical coding or billing, or equivalent combination of relevant education and experience.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• 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 work cross-collaboratively in a highly matrixed organization.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

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

Pay Range: $19.64 - $42.55 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.