JOB DESCRIPTION Job Summary Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES - Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements. - Monitors sources to ensure all updates are aligned. - Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. - Conducts analysis to identify root causes and assist with problem management as it relates to state requirements. - Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. - Provides support for requirement interpretation inconsistencies and complaints. - Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. - Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES - Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation is agreed on and clear for solutioning. - Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. - Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. - Ability to concisely synthesize large and complex requirements. - Ability to organize and maintain regulatory data including real-time policy changes. - Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. - Ability to work independently in a remote environment. - Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications - At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience along with Medical Billing and coding experience - Policy/government legislative review knowledge. - Strong analytical and problem-solving skills. - Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams. - Previous success in a dynamic and autonomous work environment. Preferred Qualifications - Project implementation experience - Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). - Medical Coding certification. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

• Receive hands-on training and feedback on assigning codes to patient accounts • Gain experience to become an independent medical coder • Reviews work queue assignments and prioritizes by date, charges and payors • Assigns and sequences diagnosis and procedure codes using appropriate classification systems • Follows coding guidelines and billing requirements to ensure compliance • Verify charge entries are accurate based on the documentation provided • Identify and escalate any obstacles to fulfilling job responsibilities

UPMC Corporate Revenue Cycle is hiring a Coder II- Profee to join our Coding Department! This position will be a work-from-home position working Monday through Friday during business hours. This role will have the same responsibilities as a Coder I. The position will review all pertinent physician, nursing, and ancillary documentation. Depending on the type of service and place of service, you will determine the level of acuity, procedure(s) performed, billable supplies, and diagnosis to substantiate medical necessity. As well as review and sequence all codes to maximize reimbursement and address any potential bundling issues. The Coder II will apply modifiers as needed. The position will also handle LMRP/CCI edit and coding denial resolution. We are looking for coders with prior experience in ENT coding to join the team. If you are ready to take the next step in your coding career, look no further! Responsibilities: - Utilize computer applications and resources essential to completing the coding process efficiently. - Meet and maintain charge lag and appropriate coding productivity standards within the time frame established by management staff. - Refer problem accounts to appropriate coding or management personnel for resolution. - Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification to accurately complete the coding process. - Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement. - Make forward progress within the period toward meeting coding accuracy standards of the departments within the first year of employment. Meet appropriate coding productivity standards within the time frame established by management staff. - Utilize standard coding guidelines, principles and coding clinics to assign the appropriate ICD and CPT codes for all record types to ensure accurate reimbursement. (i.e. use of coding clinics, CPT Assistant, etc) and to determine the level of acuity. Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. - Adhere to internal department and system-wide competencies, behaviors, policies and procedures to ensure efficient work processes. Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. Maintain continuing education by reviewing updated CPT assistant guidelines and updated coding clinics. - Complete work assignments in a timely manner and understand the workflow of the department. Maintain daily productivity statistics and submit a weekly productivity sheet to management. - High school graduate or equivalent. - In lieu of 2 years of coding experience with schooling, a minimum of 3 years experience or CPC certification required. - Graduate of an approved certified coding program preferred with a curriculum that includes Anatomy and Physiology, Pharmacology, Pathophysiology, Medical Terminology, ICD-9-CM and CPT Coding Guidelines and Procedures. - Proficient computer skills with MS excel knowledge preferred. Licensure, Certifications, and Clearances: - Eligible for CPC or CPC specialty certification. - Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Role Description Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. - Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes to ensure alignment to regulatory baseline requirements and any health plan developed requirements. - Monitors sources to ensure all updates are aligned. - Leads coordinated development and ongoing management/interpretation review process, committee structure and timing with key partner organizations. - Conducts analysis to identify root causes and assist with problem management as it relates to state requirements. - Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. - Provides support for requirement interpretation inconsistencies and complaints. - Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. - Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Qualifications - At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience along with Medical Billing and coding experience. - Policy/government legislative review knowledge. - Strong analytical and problem-solving skills. - Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams. - Previous success in a dynamic and autonomous work environment. Requirements - Project implementation experience. - Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). - Medical Coding certification. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.