Pre-Pay Dispute Coding Analyst (Inpatient and Outpatient Coding Preferred) - REMOTE

Job Summary

Essential Job Duties

Reviews coding-related provider claims denials by systematically examining medical records, denial reasons, submitted claims, and claim history, in accordance with applicable state, federal, and Molina guidelines, rules, and protocols, to determine whether the documentation substantiates the services rendered.

Conducts independent audits of non-medical records to verify billing accuracy; makes decisions within designated authority to either overturn or uphold denials in a timely manner.

Generates and communicates determination to the provider using appropriate letter language and provides necessary guideline links.

Identifies, documents, and communicates any identified coding errors or inconsistencies; collaborates with appropriate internal departments to capture and track issues, and ensure precise code editing and compliance.

Completes data points within internal applications to comply with departmental auditing requirements.

Enhancement of Departmental Processes

Actively participates in the enhancement of departmental processes to maintain alignment with current coding regulations and guidelines, while also refining internal procedures.

Required Qualifications

• At least 2 years of experience in medical coding or billing, or equivalent combination of relevant education and experience.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• Strong attention to detail and ability to independently read and comprehend the details of medical records.
• Comfortable 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.
• Microsoft Office suite and applicable software program(s) proficiency.

Pay Range

$19.64 - $42.55 / HOURLY