Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.
• Detects potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns.
• Performs medical record audits in order to validate coding accuracy.
• Performs, as required, non-medical record review audits to validate billing accuracy.
• Generates and provides accurate and timely written reports for internal and/external use detailing audit findings.
• Renders provider coding education as appropriate based on coding guidelines, contractual, and/or regulatory requirements.
Associate's Degree or equivalent combination of education and experience
Required License, Certification, Association
Current coding certification (CPC or CCS).
Bachelor's degree in health care related area.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Apply on company website