Medical Coder II

Job Title: Medical Coder II
Location: 100% Remote (U.S. - Molina approved states)
Schedule: Full-time, Monday-Friday, 8:30 AM - 4:30 PM (local time zone)
Pay Rate: $21.50/hour
Employment Type: 6-month contract (with potential for extension or conversion to full-time)

Position Summary

The Coding Specialist is responsible for performing detailed chart reviews, determining principal diagnoses, and supporting claims repricing activities. This role requires strong expertise in medical coding standards, risk adjustment practices, and regulatory compliance. The specialist will collaborate with internal teams and providers to ensure accurate coding, improve documentation practices, and support overall operational efficiency.

Key Responsibilities

• Perform ongoing chart reviews and accurately abstract diagnosis codes
• Determine principal diagnoses across multiple coding concepts
• Support claims repricing activities to ensure proper reimbursement
• Review provider billing practices to ensure accurate submission of diagnosis and CPT codes
• Document findings from chart audits and provide feedback to providers, management, and staff
• Develop educational materials, tools, and communications to support accurate coding practices
• Deliver training and education to providers on coding updates and risk adjustment guidelines
• Monitor provider performance to ensure compliance with CMS (Centers for Medicare & Medicaid Services) guidelines
• Collaborate with Clinical Informatics to identify system issues and recommend improvements
• Build and maintain strong relationships with providers by offering coding guidance and support
• Coordinate administrative activities such as scheduling chart reviews, obtaining medical records, and organizing training sessions
• Partner with cross-functional teams (Finance, Revenue Analytics, Claims, Medical Directors) on various initiatives
• Assist with CMS Data Validation efforts, including record tracking and submission
• Maintain current knowledge of coding regulations through continuing education and professional development

Required Qualifications

• Active and unrestricted coding certification: CIC or CCS (required)
• Associate degree or equivalent combination of education and experience
• Minimum of 2+ years of experience in a healthcare setting
• Minimum of 2+ years of experience in coding and medical chart review
• Experience with facility inpatient coding
• Proficiency in Microsoft Excel

Required Skills & Competencies

• Strong knowledge of medical coding standards, guidelines, and regulations
• Familiarity with risk adjustment and billing practices
• Detail-oriented with high accuracy in coding and documentation
• Strong analytical and problem-solving skills
• Excellent communication and training abilities
• Ability to work independently in a remote environment
• Strong organizational and time management skills

Equipment Requirements

• Standard equipment (laptop, headset, keyboard, mouse)
• Dual monitors and docking station (provided or reimbursed)