Perform clinical support functions under the dietitian's guidance, ensuring therapeutic menu accuracy and appropriate temperatures for patient trays while maintaining compliance with food safety standards.

• Reviews and verifies assigned codes and sequences diagnosis and procedures according to regulations (e.g., ICD9CM, CPT, HCPCS, UHDDS, and HIPPA coding guidelines) and abstracts accurate clinical information to obtain the most specific code possible to ensure an accurate health information database. • Contacts physicians for clarification of clinical information as appropriate for account type as necessary. • Maintains up-to-date knowledge of coding and regulatory requirements to accurately assign codes for appropriate reimbursement of healthcare services. • Continue to strive to meet continuing education requirements for certification or to maintain working knowledge of on-going changes to CPT, HCPS, and ICD codes. • Utilize web-based tools, coding books, and other available resources to facilitate providing insurance companies with required information. • Utilize multiple information systems to accurately select the correct patient account in order to appropriately review and verify patient billable charges. • Participate in and assist with audits to capture lost charges and determine the accuracy of billing as necessary. • Gathers demographic, insurance, and health care encounter information from a variety of sources for the purpose of billing medical provider professional fees. • Enter and verify the appropriate demographic information, charges, and comments into the computerized billing system. • Perform manual charge entry by gathering demographic, insurance, and healthcare encounter information from a variety of sources in order to accurately bill medical provider professional fees. • Ensure information entered in the system is done in an accurate and timely manner. • Verifying charges on accounts as needed and providing detailed and accurate comments for future reference. • When necessary, create a registration in the appropriate system (EPIC) from documentation provided to accurately record encounter and accurately bill the appropriate stakeholders. • Responds to inquiries from provider offices and various internal departments in a timely and accurate professional manner.

• Reviews and verifies assigned codes and sequences diagnosis and procedures according to regulations • Abstracts accurate clinical information to obtain the most specific code possible • Contacts physicians for clarification of clinical information as appropriate • Maintains up-to-date knowledge of coding and regulatory requirements • Utilizes web-based tools, coding books, and other available resources • Verifies patient billable charges • Participates in and assists with audits to capture lost charges • Gathers demographic, insurance, and health care encounter information • Enter and verify the appropriate demographic information, charges, and comments into the computerized billing system • Ensures information entered in the system is done in an accurate and timely manner • Responds to inquiries from provider offices and various internal departments in a timely and accurate professional manner

Job Description Job Summary: Develop and oversee enterprise clinical data management strategy and governance activities to optimize payer-provider clinical digital data exchanges for completeness, accuracy, and regulatory compliance while maximizing efficiency and value to Molina Healthcare and our providers. Lead enterprise discovery to inventory Use Cases for bi-directional clinical data exchange and digital transactions across the enterprise. Develop a strategy and a prioritized roadmap for enhanced data capabilities that increase efficiency through technology, create enterprise value, and elevate Molina as a preferred payer partner to providers. This role is also responsible for establishing data policies, standards, and report on key metrics. This leader will collaborate with leadership to align business priorities, budget, and technology innovation related to clinical data management. Purpose: This initiative establishes an enterprise-level strategy and governance model to address fragmented payer-to-provider clinical digital data exchanges that no single Molina function can solve independently. Independent decisions to deploy new capabilities and scale across COE, Quality, Risk, Clinical, UM, Payments/PI, and related teams have resulted in redundant data sources, duplicative provider interactions, avoidable cost, and inconsistent and/or abrasive provider experience. Today, there is no single enterprise forum where a holistic strategy is defined and where data capability roadmap and trade-off decisions are made. As we further expand CDE sources and technologies, such as the Epic Payor Platform, as well as rapidly evolve to digital regulatory mandates, these inefficiencies and issues will only increase without rationalization, on ongoing “living” strategy, and a forum to make enterprise investment decisions. Objectives The objectives and outcomes of the CDE Strategy Group will be three-fold - Enterprise Discovery - Inventory major use cases for bi-directional clinical data and digital transactions across the enterprise - push, pull, chase – to create or amplify value. - Document industry best practices and trends (including AI), regulatory requirements for digital data and electronic transactions, and provider abrasion factors. - Evaluate the completeness, accuracy, acquisition efficiency, and cost of each data source. - Strategy – Develop a strategy and a prioritized roadmap for improvement across data capabilities and functions with associated business cases, which also elevates Molina as a preferred payer partner to providers. Roadmap should address the impact of digital advances on the composition of various staffing, departments, partners in a multi-year roadmap. - Governance – Establish a governance process for collaborating across the enterprise (business and IT), and for adding new data sources, technologies, and partners. Knowledge/Skills/Abilities - Experience product managing clinical data acquisition including EMR and other data source integrations, data source rationalization, business case development, and build-buy decisions - Manages and leads high-performing, cross-functional teams throughout large-scale data management and governance initiatives; drives a culture of continuous improvement to ensure timely delivery of all commitments. - Collaborates with enterprise clinical and risk functional areas to enhance or create solutions. - Analyzes current business practices, processes and procedures, and collaborates with enterprise clinical, risk, and payment functional areas to identify business opportunities and regulatory mandates to enhance or create solutions. - Ability to understand, synthesize, and communicate complex business requirements into a prioritized solution roadmap. - Designs and oversees clinical data governance bodies (e.g. steering committee, data councils, etc.) and policies, standards, and KPIs as well as identifies roles and responsibilities. - Collaborate with IT Leadership to assess and size clinical data solutions to ensure that accurate and complete data is accessible and available to support operations and management decision-making. - Communicates the business value forecasted and achieved to key stakeholders and reports project statuses and needs to Leadership regularly. Job Qualifications Required Education: Bachelor's degree in computer science, data analytics, information technology, or similar field. Required Experience:10+ years of related clinical data experience. Preferred Education: Master's or other Graduate degree. Preferred Experience - 5+ years of management experience with demonstrated experience in strategic planning and implementation. - Deep healthcare industry expertise with extensive knowledge of industry best practices. - Proven history of executing change management and building credibility with key stakeholders to drive organizational change. - Strong critical-thinking and strategic leadership abilities to achieve ambitious business objectives and goals. - Highly skilled in planning and delivering multiple critical, complex projects. - Excellent interpersonal skills to foster relationships across multiple organizations. - Ability to effectively communicate data governance concepts and principles to non-technical constituents. - Extensive data management and analytics experience. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.