Healthcare - Medical Coder II

Metaintro, Inc.; United States; Hybrid; USD 70,000 - 100,000; Full time

Job summary

Metaintro, Inc. seeks a Specialist, Coding to perform chart reviews, educate physicians, and maintain deep knowledge of coding rules to support Molina initiatives.

The role focuses on principal diagnoses and CPT coding, with collaboration across clinical informatics and provider networks. Candidates must hold CIC or CCS certification and Excel proficiency for success in a fast-paced environment.

Qualifications

• Proficient with Microsoft Excel.
• Experience with facility inpatient coding.
• Associates degree or equivalent combination of education and experience.

Responsibilities

• Performs ongoing chart reviews and abstracts diagnosis codes.
• Develop an understanding of current billing practices to ensure diagnoses and CPT codes are submitted correctly.
• Coordinate with Clinical Informatics on system errors and suggest improvements.
• Documents results and provides feedback to management, providers, and staff.
• Creates educational materials for providers to support correct coding practices.
• Provides training on risk adjustment updates to the network of providers.
• Monitors provider progress to ensure CMS guidelines are followed.
• Builds relationships and offers coding assistance to Molina as needed.
• Plans and schedules chart reviews, obtains medical records, and coordinates education.
• Supports CMS Data Validation activities with the Coding Manager.

Skills

CIC

CCS

Education

Associate degree

CIC/CCS Certification

Tools

Microsoft Excel

Job description

Job Title: Specialist, Coding
Will this role be fully remote?: Role is fully remote
Are there any specific locations the candidates should be in (i.e., do they need to live in IL): Anywhere US (approved Molina States)
What are the day to day job duties?: Coding for multiple concepts to determine principal diagnosis as well as working with repricing the claims
Top Skills Required: CIC or CCS coding certification
What additional IT equipment is required outside of a laptop/headset/mouse/keyboard (i.e., dual monitor & docking station or single monitor & connecting cables – note these will be billed back to Molina at cost): Dual monitors and docking station
Is there potential for this to extend past 6 months and/or convert to an FTE?: yes, potential to extend past 6 months

Job Description:

Directly responsible and accountable for performing chart reviews, physician education, and maintaining comprehensive knowledge of coding rules and regulations. Provide overall coding expertise as well as administrative and technical oversight to ensure successful integration of Molina initiatives

Must Have Skills:

Proficient with Microsoft Excel Experience with facility inpatient coding

Day to Day Responsibilities:

• Performs on-going chart reviews and abstracts diagnosis codes
• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly
• Coordinate with Clinical Informatics on system errors and suggest improvements to ensure effective and efficient processes are followed
• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff
• Creates necessary tools (educational materials, newsletters, etc.) for providers to assist them in current and accurate coding practices
• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment
• Monitors progress of providers to ensure Guidelines set forth by CMS (Centers for Medicare and Medicaid Services) are being followed
• Builds positive relationships between providers and Molina by providing coding assistance when necessary.
• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education
• Collaborates with cross-functional team to support a variety of projects such as implementation of risk adjustment applications, development of reports, etc.
• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors
• Assists in coordinating CMS Data Validation activities, including record selection, tracking and submission, in conjunction with the Coding Manager of the RAMP Department
• Maintains professional and technical knowledge by attending educational workshops reviewing professional publications establishing personal networks participating in professional societies
• Contributes to team effort by accomplishing related results as needed

Required Years of Experience:

More than 2 years experience in a healthcare setting More than 2 years experience in coding and medical record chart review

Required Licensure / Education:

Associates degree or equivalent combination of education and experience Active and unrestricted Coding Certification (CIC or CCS)