Dispute Coding Analyst — Pre-Pay Claims Review

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

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.