Certified Coder (Risk Adjustment Coding Required)

Molina Healthcare; United States; On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare seeks a Medical Coder to support coding activities, ensuring ICD-10 and CPT codes are reported accurately to maintain compliance and minimize denials. This role contributes to quality and cost-effective member care.

Responsibilities include chart reviews, abstracting codes, educating providers on risk adjustment, and collaborating with finance, revenue analytics and clinical leadership to improve coding accuracy and denials prevention.

Qualifications

• Minimum 2 years of medical coding experience.
• CPC and CCS certifications required.
• Knowledge of CMS and AHA clinic coding guidelines.
• HIPAA compliance and data confidentiality.
• Ability to interface with staff, clinicians and management.

Responsibilities

• Performs ongoing member chart reviews and abstracts ICD-10 and CPT codes.
• Ensures codes are compliant and minimizes denials.
• Documents findings and provides feedback to leadership.
• Provides training on risk adjustment coding to provider network.
• Collaborates with finance, revenue analytics, claims and medical directors.
• Maintains professional knowledge through workshops and publications related to medical coding.

Skills

Medical coding

HIPAA compliance

Communication skills

Interpersonal skills

Attention to detail

Education

CPC Certification

CCS Certification

CRC Certification

CPC-P Certification

CCS-P Certification

Tools

Microsoft Office

Job description

Job Summary

Provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials.
• Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately.
• Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff.
• Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment.
• Builds positive relationships between providers and the business by providing coding assistance as needed.
• Facilitates administrative duties such as planning, chart reviews scheduling, medical records procurement, provider training and education.
• Assists in coordination of management activities with other departments including finance, revenue analytics, claims, encounters and enterprise/plan medical directors.
• Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks and participating in professional societies related to medical coding in the managed care industry.

Required Qualifications

• At least 2 years medical coding experience, or equivalent combination of relevant education and experience.
• Certified Professional Coder (CPC).
• Certified Coding Specialist (CCS).
• Latest Centers for Medicare and Medicaid Services (CMS) and American Hospital Association (AHA) clinic coding knowledge.
• Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to effectively interface with staff, clinicians, and management.
• Excellent verbal and written communication skills.
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and all other customers.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Certified Risk Adjustment Coder (CRC).
• Certified Professional Payer – Payer (CPC-P).
• Certified Coding Specialist – Physician Based (CCS-P).
• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model.
• Background in supporting risk adjustment management activities and clinical informatics.
• Experience with risk adjustment data validation.

Molina Healthcare offers a competitive benefits and compensation package.

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