Healthcare - Medical Coder II

Medical Coding Specialist

Remote role must live within one of the fifteen preferred states. Monday to Friday 8am-4:30pm requires dual monitors and a docking station. 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.

• Proficient with Microsoft Excel

• 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

• Other duties as assigned.

• More than 2 years experience in a healthcare setting

• More than 2 years experience in coding and medical record chart review

• Associates degree or equivalent combination of education and experience

• Active and unrestricted Coding Certification (CIC, CPC, CCS, RHIT, or RHIA)

Summary: Serves as the primary resource for medical coding updates and information. Advises client on coding issues, provides in-depth research on new or unusual procedures, and makes recommendations when appropriate. Provides support to the Claims and Provider Relations Departments.

Essential Functions:

• Reviews and researches billed unlisted procedure codes to determine if a more specific code exists.
• Supplies cover and pricing information to client Medical Director regarding unlisted codes.
• Conducts meetings with state client to discuss procedure code coverage and ensures coding decisions are implemented.
• Responsible for archiving all Procedure Code Workgroup (PCW) agendas, minutes, and related materials.
• Maintains HIPAA reason and remark code lists and provides code updates to the HIPAA Code Workgroup, when necessary.
• Supports the Claims Department by working edit reports as assigned.
• Provides Provider Relations with coding issues and updates to be shared with providers to ensure timely and accurate claim payment.
• Maintains a library of code books and relevant resources to be available to personnel, when necessary.
• Serves as a resource for the client and co-workers with question related to coding issues.

Knowledge/Skills/Abilities:

• Proficient in MS Office Suite
• Ability to work independently, with minimal supervision
• Excellent verbal and written communication skills
• Ability to abide by Molina's policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education: Bachelor's Degree or equivalent experience

Required Experience: 2-4 years in professional coding experience, professional or hospital. Knowledge of insurance claims processing.

Required Licensure/Certification: Certified Professional Coder (CPC)