Pre-Pay Dispute Coding Specialist

Molina Healthcare; United States; Remote; USD 60,000 - 85,000; Full time

Job summary

Molina Healthcare in the United States is seeking a Coding Disputes Specialist to support provider denial coding dispute activities and ensure claims align with applicable billing standards and Molina guidelines.

You will review denials, audit medical records, communicate determinations to providers, and collaborate with internal teams to correct coding errors while maintaining high quality and regulatory compliance.

Qualifications

• At least 2 years of experience in medical coding or billing.
• 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.

Responsibilities

• Reviews coding-related provider claims denials by systematically examining medical records, denial reasons, submitted claims, and claim history, to determine whether documentation substantiates services rendered.
• Conducts independent audits of non-medical records to verify billing accuracy and overturns or upholds denials in a timely manner.
• Generates and communicates determinations to providers with appropriate language and guideline links.
• Identifies and communicates coding errors or inconsistencies; collaborates with internal departments to capture and track issues.
• Completes data points within internal applications to comply with auditing requirements.
• Participates in enhancing departmental processes to align with coding regulations and guidelines.

Skills

Attention to detail

Communication

Microsoft Office proficiency

Cross-functional collaboration

Education

CPC or CCS certification

Job description

Molina Healthcare in the United States is seeking a Coding Disputes Specialist to support provider denial coding dispute activities and ensure claims align with applicable billing standards and Molina guidelines.

You will review denials, audit medical records, communicate determinations to providers, and collaborate with internal teams to correct coding errors while maintaining high quality and regulatory compliance.