Senior Specialist, Coding
M
Molina HealthcareHealthcare Coding
United StatesFull-TimeSenior
Salary not disclosed
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Job Details
- Experience
- 3–5+ years
- Required Skills
- Microsoft Excel
Requirements
- Associate’s Degree or equivalent work experience.
- 3–5+ years of coding, payment integrity, or claims experience in a healthcare setting.
- Experience supporting coding accuracy, correct coding edit review, savings analysis, and operational workflows.
- Active and unrestricted coding certification, such as CPC, CCS, CCS-P, RHIT, or equivalent.
- Bachelor’s Degree in Business, Healthcare, or a related field (preferred).
- Experience in prepayment coding programs and payer environments (preferred).
- Exposure to working with coding vendors and Health Plan partners (preferred).
- Familiarity with state-specific coding and reimbursement guidelines (preferred).
- Proficiency in Excel for tracking, reporting, and trend identification (preferred).
Responsibilities
- Serve as the primary subject matter expert and Health Plan point of contact for assigned state(s), Health Plans, or edit categories.
- Research, analyze, and support correct coding edit accuracy and savings for assigned work.
- Apply state, federal, industry, and vendor coding guidance when researching correct coding edit outcomes.
- Review edit outcomes and coding rationale to identify inconsistencies, risks, savings impact, and improvement opportunities.
- Monitor coding-related trends, savings indicators, and performance outcomes to identify potential variations.
- Support day-to-day triage and resolution of coding edit inquiries impacting assigned work.
- Assist in resolving coding edit questions, savings inquiries, and escalations from Health Plans and internal teams.
- Partner with prepay editing vendors and internal stakeholders to research inquiries and clarify coding edit expectations.
- Communicate coding insights, edit findings, and savings-related observations to internal stakeholders and Health Plan partners.
- Provide recommendations to improve consistency, edit accuracy, and coding outcome quality.
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