Senior Specialist, Coding - Chart Audit/Behavioral Health

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Molina HealthcareHealthcare coding

Source API remote eligibility restrictions: United StatesFull-TimeSenior

Salary not disclosed

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Job Details

Experience: At least 4 years of medical coding, auditing, and/or compliance experience, or equivalent combination of relevant education and experience.
Required Skills: Microsoft OfficeCompliance

Have at least 4 years of medical coding, auditing, and/or compliance experience, or an equivalent combination of relevant education and experience.
Hold a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification.
Be skilled in reviewing medical and clinical documentation.
Be able to collaborate in a cross-functional, highly matrixed organization.
Be able to develop feedback and training tools.
Be able to present educational materials to relevant groups, including medical professionals.
Have proficiency with Microsoft Office suite and applicable software programs.
Familiarity with the Hierarchical Condition Categories (HCC) risk adjustment model is preferred.
Experience supporting risk adjustment management activities and clinical informatics is preferred.

Perform ongoing chart reviews and abstract diagnosis codes.
Review provider billing practices to ensure diagnosis and CPT codes are submitted accurately.
Conduct coding reviews and audits for accuracy and compliance.
Research and resolve coding discrepancies and rejected or denied claims or encounters.
Document chart review findings and provide feedback to leadership, providers, and office staff.
Develop educational materials and train providers on risk adjustment best practices and coding updates.
Coordinate CMS data validation activities, including record selection, tracking, and submission.
Collaborate with cross-functional teams on risk adjustment applications and reports.

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