Analyst, Pre-Pay Dispute Coding (Remote)

Molina Healthcare•Long Beach, CA

4d•Remote

About The Position

Provides support for provider denial coding dispute activities. Investigates and resolves disputes related to provider appeals and ensures claims adhere to correct billing standards and regulations. The role reviews coding-related provider claim denials, examines medical records and claim information, and determines whether the documentation substantiates the services rendered. It also audits non-medical records, communicates determinations to providers, and supports accurate code editing, compliance, and departmental process improvement.

Requirements

At least 2 years of experience in medical coding or billing, or an equivalent combination of relevant education and experience.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification.
Strong attention to detail and ability to independently read and comprehend medical records.
Comfort working in a production-centric environment with high quality standards.
Ability to work cross-collaboratively in a highly matrixed organization.
Effective verbal and written communication skills.
Proficiency with the Microsoft Office suite and applicable software programs.

Responsibilities

Review coding-related provider claim denials by examining medical records, denial reasons, submitted claims, and claim history in accordance with applicable state, federal, and Molina guidelines, rules, and protocols.
Conduct independent audits of non-medical records to verify billing accuracy and decide within designated authority whether to overturn or uphold denials in a timely manner.
Generate and communicate determinations to providers using appropriate letter language and provide necessary guideline links.
Identify, document, and communicate coding errors or inconsistencies; collaborate with internal departments to capture and track issues and ensure precise code editing and compliance.
Complete data points in internal applications to meet departmental auditing requirements.
Participate in enhancing departmental processes to align with current coding regulations and guidelines and refine internal procedures.