Analyst, Pre-Pay Dispute Coding (Remote)

Molina Healthcare•United States,

5h•$20 - $43•Remote

About The Position

Provides support for provider denial coding dispute activities by investigating and resolving disputes related to provider appeals and ensuring claims adhere to correct billing standards and regulations. The role reviews coding-related provider claim denials, examines supporting records and claim information, and determines whether documentation substantiates the services rendered. It also communicates determinations to providers, documents coding issues, completes internal audit data, and helps improve departmental processes and procedures.

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 Microsoft Office suite and applicable software programs.

Responsibilities

Review coding-related provider claims 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 make timely decisions within designated authority to overturn or uphold denials.
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 accurate code editing and compliance.
Complete data points within internal applications to meet departmental auditing requirements.
Participate in enhancing departmental processes to maintain alignment with current coding regulations and guidelines and refine internal procedures.