Molina Healthcare · 7 hours ago
Analyst, Pre-Pay Dispute Coding (Remote)
United States
Full-time
Remote
Entry Level
$21.82/hr - $51.06/hr
2+ years expMolina Healthcare is a provider of healthcare services, and they are seeking an Analyst for Pre-Pay Dispute Coding. The role involves investigating and resolving disputes related to provider appeals, ensuring compliance with billing standards and regulations.
HealthcareHospitalHealth CareMedical
Responsibilities
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, making decisions within designated authority to either overturn or uphold denials in a timely manner
Generates and communicates the determination to the provider using appropriate letter language and providing any necessary guideline links
Identifies, documents, and communicates any identified coding errors or inconsistencies, collaborating with appropriate internal department(s)to capture and track issues to ensure precise code editing and compliance
Completes data points within internal applications to comply with auditing requirements used within the departments of Molina
Actively participates in the enhancement of departmental processes to maintain alignment with current coding regulations and guidelines, while also refining internal procedures
Qualification
Required
At least 2 years of experience in medical coding or billing
Active and unrestricted Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification
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 use Microsoft Office including Outlook, Word, and Excel
Benefits
Competitive benefits and compensation package
Company
Molina Healthcare
Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$2.35B2025-11-17Post Ipo Debt· $850M
2024-11-13Post Ipo Debt· $750M
2021-11-16Post Ipo Debt· $750M
Leadership Team
Dave Reynolds
Executive Vice President, Health Plans & Medicaid Chief Operating Officer
Debbie Simkins
Vice President, Office of the CIO
Recent News
Investor's Business Daily
2026-02-09
legacy.thefly.com
2026-02-07
2026-02-07
Company data provided by crunchbase