Senior Specialist, Coding (Remote)
M
Molina Healthcare
📍 United States, United States, United States
Job Description
JOB DESCRIPTION
The Senior Specialist, Coding supports Payment Integrity Prepay operations by researching correct coding edit inquiries, analyzing edit outcomes, validating coding rationale, and monitoring savings and accuracy trends within assigned scope. This role partners with Health Plans, vendors, and internal stakeholders to support consistent application of coding guidelines, timely issue resolution, savings integrity, and accurate claim edit outcomes.
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Essential Job Duties
• Provides senior level coding expertise and administrative technical oversight to ensure successful integration of departmental initiatives.
• Performs ongoing chart reviews and abstracts diagnoses codes in alignment with the Hierarchical Condition Categories (HCC) model.
• Leverages understanding of current billing practices in provider offices to ensure that diagnoses codes are submitted appropriately.
• Documents results/findings from chart reviews, and provides ...
The Senior Specialist, Coding supports Payment Integrity Prepay operations by researching correct coding edit inquiries, analyzing edit outcomes, validating coding rationale, and monitoring savings and accuracy trends within assigned scope. This role partners with Health Plans, vendors, and internal stakeholders to support consistent application of coding guidelines, timely issue resolution, savings integrity, and accurate claim edit outcomes.
.
Essential Job Duties
• Provides senior level coding expertise and administrative technical oversight to ensure successful integration of departmental initiatives.
• Performs ongoing chart reviews and abstracts diagnoses codes in alignment with the Hierarchical Condition Categories (HCC) model.
• Leverages understanding of current billing practices in provider offices to ensure that diagnoses codes are submitted appropriately.
• Documents results/findings from chart reviews, and provides ...