Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Certified Coder, Risk Adjustment
Location
Arizona
Posted
15 days ago
Salary
$20 - $39 / hour
Seniority
Senior
Job Description
Certified Coder, Risk Adjustment
Molina Healthcare
Certified Coder (Risk Adjustment Experience Required) - REMOTE Molina Healthcare AZ, United States; Arizona; Job ID 2037743 JOB DESCRIPTION Job SummaryProvides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials. • Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately. • Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff. • Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment. • Builds positive relationships between providers and the business by providing coding assistance as needed. • Facilitates administrative duties such as planning, chart reviews scheduling, medical records procurement, provider training and education. • Assists in coordination of management activities with other departments including finance, revenue analytics, claims, encounters and enterprise/plan medical directors. • Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks and participating in professional societies related to medical coding in the managed care industry. Required Qualifications• At least 2 years medical coding experience, or equivalent combination of relevant education and experience. • Certified Professional Coder (CPC). • Certified Coding Specialist (CCS). • Latest Centers for Medicare and Medicaid Services (CMS) and American Hospital Association (AHA) clinic coding knowledge. • Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). • Ability to effectively interface with staff, clinicians, and management. • Excellent verbal and written communication skills. • Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and all other customers. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Risk Adjustment Coder (CRC). • Certified Professional Payer – Payer (CPC-P). • Certified Coding Specialist – Physician Based (CCS-P). • Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model. • Background in supporting risk adjustment management activities and clinical informatics. • Experience with risk adjustment data validation. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $19.84 - $38.69 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Job Type Full Time
Related Guides
Related Categories
Related Job Pages
More Medical Billing and Coding Jobs
Mid-Level Inpatient Coding Specialist
AdventHealthAdventHealth is on a Christian mission to “extend the healing ministry of Christ” by focusing on whole-body restoration and wellness. Led by President and C
Mid-Level Inpatient Coding Specialist Req #: R-0364055 Job Category: Health Information Management Location: Orlando, FL Pay Range: $21.73 – $40.42 Location Type: Fully Remote Facility: AdventHealth Corporate Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: - Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance - Paid Time Off from Day One - 403-B Retirement Plan - 4 Weeks 100% Paid Parental Leave - Career Development - Whole Person Well-being Resources - Mental Health Resources and Support - Pet Benefits Schedule: Full time Shift: Day (United States of America) Address: 601 E Rollins St City: Orlando State: Florida Postal Code: 32803 Job Description: Queries physicians for clarification of discrepancies, additional diagnoses, complications, or co-morbid conditions as needed. Applies ICD-10-CM/PCS codes, MS-DRG codes, Present on Admission codes, and patient status codes, understanding their impact on mortality rates, clinical quality, reimbursement, internal scorecards, and key performance indicators. Utilizes a thorough understanding of the Official Coding Guidelines, Coding Clinic guidance, medical necessity, and coverage determinations. Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance. Reviews encounters for proper admission source, discharge disposition, and assigns the operative physician and date of procedure to the chart coding screen. Works with other Coding team members to keep coding within two days of discharge and hospital coding days within three days. Completes coding for multiple facilities in a timely manner. Other duties as assigned. Reviews, analyzes, and interprets clinical documentation to apply appropriate ICD-10-CM/PCS coding conventions and MS-DRG Medicare Prospective Payment System requirements. Evaluates and optimizes various DRG options in accordance with UHDDS rules, official coding guidelines, regulatory agencies, and approved policies. Verifies CAC codes and ensures diagnostic and procedure codes are supported by the physician’s clinical documentation. Communicates with physicians and allied health personnel to ensure comprehensive, accurate, and timely clinical documentation. Discusses optimization and documentation issues with physicians and clinical personnel to ensure optimal coding and reimbursement. Knowledge, Skills, and Abilities: • Thorough knowledge of Medicare reimbursement methodology, documentation guidelines, data abstraction, and encoder functionality. [Required] • Ability to communicate effectively with physicians and physician office staff [Required] • Computer skills, including Microsoft Office and Encoder software [Required] • Self-motivated and able to work independently in a remote setting [Required]• Critical thinking and problem-solving skills [Required] • Comprehensive knowledge of coding functions, rules, and guidelines as it relates to DRG assignment [Required] • Thorough knowledge of medical terminology, anatomy and physiology, and pathophysiology [Required] Education: • Associate [Preferred] • High School Grad or Equiv [Required] Field of Study: • Associate degree in Health Information Managment or medical coding certification required Work Experience: • 3+ of inpatient hospital coding experience, including cases requiring specialized coding skills, such as cardiovascular surgery, neurosurgery, trauma surgery, neonatology, pediatrics, plastic and reconstruction surgery, bariatric surgery, cardiology, and other services and procedures provided in a tertiary care facility. [Required] • Extensive experience with cases requiring more complex coding skills, such as advanced cardiovascular, cardiothoracic, neurological, and orthopedic surgical procedures, extended or prolonged length of stays (> 100 days), BMT and other solid organ transplantations, ECMO, cutting-edge surgical advancements that are considered new and innovative, procedures that may be considered experimental or research-based, and other complicated treatments or procedures provided in a quaternary care facility. [Preferred] Additional Information: • N/A Licenses and Certifications: • Registered Health Information Administrator (RHIA) [Required] OR • Registered Health Information Technician (RHIT) [Required] OR • Certified Coding Specialist (CCS) [Required] OR • Certified Professional Coder (CPC) [Required] Pay Range: $21.73 – $40.42
Medical Coding Instructor
Weston Distance LearningWeston Distance Learning, founded in 1981, is one of the nation’s largest distance-learning education institutions. For nearly 30 years, Weston Distance Learn
Medical Coding Instructor Location: Remote Type: Part Time Min. Experience: Experienced Health Information Technology/Medical Specialties Instructor Weston Distance Learning (WDL) has provided distance education for more than 40 years. Weston's mission is to help people change their lives through distance education by providing high-quality, flexible training at an affordable tuition. We offer the ability to work from your home office, a flexible schedule and part-time leave. Weston Distance Learning is currently seeking a Health Information Technology (HIT) and Medical Specialties (MS) Instructor to help train students in the area of Medical Coding. This is a part-time work-from-home position with the instructor working from a home office using our online learning platform. Responsibilities include: - Review and manage courses and exams, including grading and using innovative ways to provide content coaching. - Focus on helping students through tutoring appointments, email and online messaging through our LMS. - Model effective oral and written communication that engages the students, providing clarity, and improving student learning. - Demonstrate consistency and fairness in the grading of exams and provide timely feedback to students. - Work with the Curriculum Department in conducting Academic Reviews and other projects to ensure content is relevant and current. Requirements include: - Candidates must possess a minimum of a Bachelor's degree in Health Information Technology or a closely related field. - Must have at least 5 years full-time work experience and be currently employed in the Medical Coding field. - ICD-10-CM, ICD-10-PCS, CPT and HCPCS knowledge and experience. - Certification as a Certified Professional Coder (CPC) and Certified Coding Specialist (CCS) with ability to provide verification of certification scores. - Candidates must hold a degree earned from an institution accredited by an agency that is recognized by the United States Secretary of Education and/or the Council for Higher Education Accreditation (CHEA) or, for non-U.S. institutions, an accepted foreign equivalent that is listed in the International Handbook of Universities (18th ed.) Starting pay is expected to be $26.50/hour but may vary based on experience.
Benefits Coordinator Remote JZ Corporate Services, Inc .Full time Atlanta, Georgia, United States Description Jacuzzi Group is a leading global manufacturer of hot tubs, swim spas, baths, showers, saunas, and pool equipment. More than four thousand global employees work across our portfolio of brands, including Jacuzzi, Sundance Spas, Hydropool Swim Spas and Hot Tubs, DreamMaker, and more. With manufacturing and warehouse operations in the United States, Canada, Mexico, Italy, the United Kingdom, France, Brazil, Chile, and Australia, we have more than 65 years of experience delivering innovative wellness products to our consumers across our many brands. Jacuzzi Group is seeking a Benefits Coordinator to provide hands-on administration and frontline employee support for the company’s health, welfare, and retirement benefit programs. This role is primarily responsible for day-to-day benefits operations, employee inquiries, enrollments, billing accuracy, and wellness program activities. The ideal candidate is highly detail-oriented, customer-service driven, and comfortable managing recurring operational processes such as monthly carrier reconciliations, new hire enrollments, and employee issue resolution. This role requires discretion, strong follow-through, and confidence working directly with employees, vendors, and payroll partners. The Benefits Coordinator role at Jacuzzi Group is fully remote, but must be located in and willing to work EST hours. Responsibilities and Duties: - Benefits Administration & Employee Support - Serve as the primary contact for employee benefits inquiries, providing prompt and compassionate support. Manage daily operations of health and welfare benefits, including medical, dental, vision, life, disability, HSA/FSA, and optional plans. - Administer new hire benefit enrollments, life event changes, terminations, and status updates in HRIS/benefits platforms. - Support annual open enrollment execution, including system setup, testing, employee communications, and post-enrollment cleanup. - Maintain benefits documentation and HRIS/benefit platforms content to improve employee self-service. - Ensure employee 401(k) elections, contribution changes, and loan transactions are accurately reflected in the payroll system. - Assist with employee retirement education by supporting communications, plan materials, and enrollment initiatives. - Billing, Enrollment Accuracy & Data Integrity - Conduct monthly carrier billing reconciliations and resolve discrepancies with carriers, payroll, and vendors. - Ensure enrollment accuracy across HRIS, benefits platforms, payroll, and carrier systems. - Track and resolve retroactive changes, refunds, and adjustments in a timely manner. - Assist with routine 401(k)-related reporting and data reconciliation as needed. - Vendor & Platform Coordination - Partner with carriers, brokers, TPAs, and benefits platform providers to resolve employee issues and operational errors. - Resolve complex cases effectively and assist with vendor data feeds, eligibility files, and platform maintenance. - Leave of Absence & Disability Support - Collaborate with HR Managers to manage leave of absence and disability benefits, ensuring timely collection of employee benefit premiums during unpaid or partially paid leave. - Process and support benefit enrollment changes related to leaves of absence, including status changes, and return-from-leave events. - Track leave and disability cases as they relate to benefits eligibility, enrollment timelines, alignment with COBRA and coverage continuity. - Partner with vendors and internal teams to ensure benefits are aligned with approved leave statuses and timelines. - Wellness Programs & Employee Engagement - ·Support the facilitation of employee wellness challenges, campaigns, and activities, partnering with vendors and internal stakeholders as needed. - Oversee wellness program participation metrics, track outcomes and trends, and manage wellness communications, calendars, and resources for employees. - Issue recognition awards and incentives for wellness initiatives. Participate in the Wellness Committee by providing insights and assisting with program implementation and success. - Compliance & Governance Support - Support compliance requirements related to COBRA, ACA, ERISA, HIPAA, Section 125, and retirement plans. - Assist with audits, reporting, and required notices and filings. - Ensure confidentiality and proper handling of sensitive employee information at all times. - Other duties as assigned Compensation: $55,000 + (based on experience) Requirements - - - 2–3 years of hands-on benefits administration experience - Ideally have some experience supporting employee-facing benefits and wellness programs - Ideally have some experience with benefits billing reconciliation and/or enrollment audits - Strong attention to detail - Customer service orientation with excellent written and verbal communication skills. - Proficiency with HRIS and benefits platforms - Strong Excel skills. - Experience supporting multi-state and/or multi-country employee populations. Benefits - Benefits - 401(k) with matching program - Dental insurance - Health insurance - Health savings account - Life insurance - Paid time off - Vision insurance
Correspondence Representative
HumanaLouisville, Kentucky-based Humana is a leading healthcare company that offers a variety of health, wellness, and insurance products and services designed to off
Role Description The Correspondence Representative 2 performs research, analysis, documentation, and interpretation for the provider reimbursement programs for an organization that provides health insurance. Updates, maintains, and reviews fee scheduling and pricing structures. Ensure contracted rates and reimbursement policies are priced and applied accurately. You will report to the Supervisor, Claims Research & Resolution. As the Correspondence Representative 2 you will: - Make reimbursement policy and process recommendations and ensure compliance with government regulations - Analyze provider reimbursement patterns and trends - Use your skills to make an impact Qualifications - 2 or more years of Customer Service and/or administrative experience (in past 5 years) - 1 or more years of Healthcare claims experience - Proficiency with Microsoft Outlook (email communication) - 1 or more year of technical experience (multiple system platforms and split screens simultaneously) Requirements - 1 or more years of Medicare and/or Medicaid experience - Familiarity with MHK knowledge - CAS experience - Familiarity with CRM knowledge - Experience with provider reimbursement policy analysis and documentation - Knowledge of regulatory requirements and compliance standards for health insurance - Microsoft Word (document creation) and Excel (formulas) Benefits - Medical, dental, and vision benefits - 401(k) retirement savings plan - Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) - Short-term and long-term disability - Life insurance - Many other opportunities Additional Information Training: - This position is scheduled to start on Monday, July 26, 2026. - This will be a virtual training for 3-4 weeks with a schedule of 8:00 AM – 4:30 PM Eastern Monday - Friday. - We may extend the Training and Nesting on business needs. - You must be on time, in a quiet environment, dressed appropriately, with your camera ON during training and for other meetings required by leadership. Work Schedule Following Training: - Following training, we require associates to have flexibility to work any 8-hour shift between the hours of 6:00 AM – 6:30 PM Eastern time, Monday - Friday. - May require some weekends and overtime, based on needs. - The initial 120 days of employment constitute an appraisal period. This Appraisal Period is necessary to your learning and development, which is why we ask for perfect attendance during both the classroom training and nesting periods. - The department has a strict attendance policy. - You will learn many systems, policies, and tools, and it takes time to become proficient in the role. You must be willing to remain in this position for a period of twelve (12) months before applying to other Humana opportunities. HireVue: - As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. - HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Work at Home: - To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. - Satellite, cellular and microwave connection can be used only if approved by leadership. - Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: - While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range: The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $40,000 - $52,300 per year




