Molina Healthcare logo
Molina Healthcare

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

Senior Specialist, Coding

Location

United States

Posted

1 day ago

Salary

$49.4K - $107.1K / year

Seniority

Senior

No structured requirement data.

Job Description

Senior Specialist, Coding

Molina Healthcare

Role Description Provides senior level support for coding activities. Responsible for monitoring adherence to Molina's compliance program, minimizing risks related to coding and billing practices, and protecting the business from liability related to fraudulent/abusive practices. Performs chart reviews, facilitates physician education, and maintains comprehensive knowledge of coding rules and regulations. - 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 feedback to leadership, providers, and office staff. - Creates necessary tools (educational materials, newsletters, etc.) for providers to support risk adjustment. - Provides training and education to network of providers on risk adjustment best practices and provides coding updates related to risk adjustment. - Monitors progress of providers to ensure guidelines set forth by Centers for Medicare and Medicaid Services (CMS) are adhered to. - Builds positive relationships between providers, and provides coding assistance as needed. - Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education. - Collaborates with cross-functional teams to support a variety of projects such as implementation of risk adjustment applications, development of reports, etc. - Coordinates related activities with departments including finance, revenue analytics, claims, encounters, and medical directors. - Coordinates CMS data validation activities, including record selection, tracking and submission, in conjunction with coding leadership. - Maintains professional and technical coding-related knowledge. Qualifications - At least 4 years of medical coding, auditing, and/or compliance experience, or equivalent combination of relevant education and experience. - Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). - Detail-oriented; skilled in medical/clinical documentation review. - Ability to collaborate in a cross-functional highly matrixed organization. - Proven experience partnering with business leaders on training design and execution, instructional design, adult learning theory and deploying training through innovative solutions, and ability to strategically approach development and implementation of clinical education across the enterprise. - Effective verbal and written communication skills, including ability to present to medical professionals. - Microsoft Office suite and applicable software program(s) proficiency. Preferred Qualifications - Familiar with the Hierarchical Condition Categories (HCC) risk adjustment model. - Background in supporting risk adjustment management activities and clinical informatics. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Related Categories

Related Job Pages

More Billing Specialist Jobs

Acosta Institute logo

Billing Analyst I

Acosta Institute

Fostering innovation at the intersection of healing-centered education, contemplative social science and slow work.

Full TimeRemoteTeam 1-10H1B No Sponsor

• Review contracts and collect data for accurate billing • Analyze data to ensure timely billing for clients with complex invoicing structures • Responsible for managing billing over $3M/month

Canada
$42.2K - $60.2K / year

LMS Integration Specialist

JoVE

JoVE is the world-leading producer and provider of video solutions with the mission to improve scientific research and education. Millions of scientists, educators and students use JoVE for their research, teaching and learning. Our institutional clients comprise over 1,000 universities, colleges, and biopharma companies, including such leaders as Harvard, MIT, Yale, and Stanford. As a rapidly growing company, with offices in the USA, UK, Australia, and India servicing clients in over 60 countries, we are seeking talented and ambitious individuals to join our company.

Role Description We are looking for a self-driven Education Technology Specialist with deep expertise in Learning Tools Interoperability (LTI). In this role, you will be responsible for the end-to-end implementation, configuration, and support of JoVE’s LTI integrations across universities and colleges globally. You will work closely with LMS administrators, IT teams, faculty, and internal stakeholders to ensure seamless integration of JoVE content into institutional learning environments. - Configure, deploy, and maintain JoVE LTI integrations across major LMS platforms including Canvas, Blackboard, Moodle, and Brightspace. - Work directly with university LMS administrators and IT teams to install and provision JoVE tools. - Manage LTI credentials, security configurations, and deployment workflows. - Perform testing, validation, and QA of integrations to ensure proper functionality (deep linking, grade passback, authentication, etc.). - Diagnose and resolve technical issues related to LTI integrations, including access errors, content launch failures, and configuration mismatches. - Collaborate with Product and Engineering teams to communicate client feedback and improve integration capabilities. Qualifications - A Bachelor’s degree - 3+ years of strong hands-on experience with LTI standards (LTI 1.1, LTI 1.3, LTI Advantage) - Experience working at the LMS administrator level (tool configuration, permissions, integrations). - Ability to troubleshoot technical issues independently. - Excellent English communication skills. - Strong organizational and problem-solving abilities. - Ability to manage multiple projects and stakeholders simultaneously. - Self-starter with a results-driven mindset. Benefits - A competitive compensation package. - You will make a direct impact in accelerating science research and education. - Opportunity to work with global teams and in an environment that promotes innovation and collaboration. - Our strong promotion from within culture draws a clear path to advance your career with us.

Worldwide
Full TimeRemoteTeam 10,001+H1B No Sponsor

Role Description The E-Billing Analyst will be responsible for all aspects of invoice submissions via various e-billing platforms and resolving e-billing issues for the law firm's e-billed clients. Excellent communication and a high level of professional service to management, attorneys, and other staff is required to succeed in this role. Must have a high level of customer service, professionalism, and interpersonal skills. The role requires various interactions with all levels of management, amid a fast-paced, deadline-driven environment. - *Work directly with the client’s E-billing Manager on any ad-hoc e-bill related management/client requests - *Responsible for the submission of electronic invoices and accruals to clients on a monthly basis, overseeing the transition of clients to e-billing, and providing follow-up support to attorneys and clients in all aspects related to electronic billing - *Handle heavy volume of highly complex e-submission assignments for key corporate clients; ensure all client guidelines, internal protocol, and firm's guidelines are followed during submission process - *Act as liaison between billing attorney/secretarial staff and clients' staff assigned to electronic billing by providing expert level subject matter support - *Liaise with billing attorney/secretary and client representatives in the resubmission of invoices; ensure corrective action is in place for future submissions - *Populate, maintain, and update data for assigned clients in the billing system and clients' external web applications; ensure all relevant information is updated and correlated in the firm's billing system - *Work collaboratively with department's supervisor to support e-billing systems by adding/removing user accounts, resetting passwords, assigning proper security levels, entering budgets, status reports, and matter profiles in various sub-systems - Perform ad hoc analyses of complex client accounts regarding collections, rates, and reduced and rejected invoices Qualifications - Associate degree or advanced degree preferred with concentration in Business, Accounting, or Finance. Commensurate experience may be considered in lieu of education, based upon candidate’s overall employment history - 1+ years of e-billing experience within a corporate law department or law firm - Knowledge of legal billing and Middleware systems a plus (i.e., Legal Exchange, Ty Metrix 360, Legal-X, Serengeti/Legal Tracker) - Proven knowledge and experience with BillBlast - Knowledge of various Legal Electronic Data Exchange Standard (LEDES) billing formats is a plus - Proficiency with Windows-based software and Microsoft Applications such as Excel, Word, and Outlook, and ability to create, edit, and present complex data, analyses, and ad hoc reports - Strong reading comprehension, analytical and problem-solving skills - Multi-task, use time efficiently and perform professionally and at a high level under tight deadlines and in a fast-paced, ever-changing work environment, and successfully prioritize and adapt to changing demands - Able to influence/steer at a senior and executive level within and outside client groups Requirements - The salary range for this role at the noted RRD location is $18.99 to $26.59 hour - Starting pay decisions are determined based on multiple factors including but not limited to relevant education, qualifications, skills, experience, certifications, proficiency, performance, shift, location, and other business needs - Typically, roles follow step progressions to a target rate or set increments over time - Depending on the role, in addition to the hourly rate of pay, the total compensation package may also include overtime, shift differential, call-in, and/or stand-by pay - RRD’s benefit offerings include medical, dental, and vision coverage, paid time off, disability insurance, 401(k) with company match, life insurance and other voluntary supplemental insurance coverages, plus parental leave, adoption assistance, tuition assistance and employer/partner discounts Benefits - Medical, dental, and vision coverage - Paid time off - Disability insurance - 401(k) with company match - Life insurance and other voluntary supplemental insurance coverages - Parental leave - Adoption assistance - Tuition assistance - Employer/partner discounts

United States
$19 - $27 / hour
Full TimeRemoteTeam 10,001

Role Description As a Documentation Specialist at AdaptHealth, you play a key role in keeping patient care moving forward. You’ll ensure the timely, accurate collection and management of patient documentation needed for compliant billing and a healthy revenue cycle. You’ll collaborate closely with physician offices, insurance providers, and internal teams to remove barriers to care and payment. - Review, analyze, and validate clinical documentation to ensure payer compliance and billing readiness - Collect and manage patient eligibility documents, including prescriptions, CMNs/LMNs, clinical notes, labs, and prior authorizations - Resolve pending revenue by reconciling documentation with outstanding charges - Request and track prior authorizations, including coordination with state Medicaid programs - Identify documentation trends or recurring issues and proactively escalate and educate internal teams and provider offices - Ensure compliance with Medicare, Medicaid, HIPAA, and private insurance regulations - Generate and manage electronic documentation requests to physicians and insurance companies - Communicate with physician offices and payers to obtain missing or incomplete documentation - Collaborate with AdaptHealth sales, support, and customer service teams to support timely billing - Maintain and update physician databases to ensure accurate communication and document delivery - Serve as backup support for customer service inquiries as needed - Meet productivity, quality, and attendance standards while contributing to a team-focused, continuous improvement culture - Perform all other duties as assigned Qualifications - High School Diploma or equivalent work experience required - One (1) year of administrative experience, including but not limited to insurance, billing, claims, call center, or financial services - Strong problem-solving skills with attention to detail - Strong verbal and written communication - Excellent customer service skills - Proficient computer and system skills - Ability to work in a fast-paced environment inclusive of multi-tasking Requirements - Company conducted Background Check is required for all roles - Company conducted Motor Vehicle Record Check is required for all driving roles - Clinical roles require valid licensure/certification, where applicable - In accordance with Florida law, candidates applying for positions located in Florida are required to undergo background screening through the Florida Care Provider Background Screening Clearinghouse, as applicable. Benefits - Comprehensive medical, dental and vision coverage (eligible first of the month following hire) - 401(k) with company match - Paid Time Off Plans including 6 paid holidays - Employee Stock Purchase Plan - Paid Parental Bonding Leave - Short and Long-term Disability Insurance - Life and AD&D Insurance - Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) - CVS Minute Clinic and Teledoc access - Spousal Advantage Reimbursement Plan - Identity Theft Protection and Legal Plan

United States