Top 7 Coding specialist Jobs in Batesville Ms

Lead Analyst, Payment Integrity - Health Plan
Molina Healthcare —Oxford, MS
- $59,811.00 - $129,589.63 a year
- Full-time
- Mid-level
- SQL
- Organizational skills
- Health insurance
DRG Integrity Specialist
Accuity —United States
- Full-time
- Research
- Mid-level
- Windows
Quick Apply

More jobs to discover

Find similar jobs that you might be interested in.

DRG Integrity Specialist
Accuity —United States
Always acts in an ethical and collaborative manner while monitoring own work to help ensure quality. Expert of coding guidelines Ability to use independent…
Quick Apply

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Remote Physician Coding Specialist II
Mount Carmel —Columbus, OH
Attends educational opportunities to enhance knowledge in coding and reimbursement systems and obtains/maintains certification from AHIMA or AAPC to validate…
Coding Specialist
Nationwide Children's Hospital —Columbus, OH
As required by listed licensure and/or certification requirement. Conducts billing and coding audits to ensure accuracy and identify missed opportunities.

Show more jobs in cities nearby

I want to receive the latest job alert for coding specialist in batesville ms

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

coding specialist jobs near batesville ms

Lead Analyst jobs in Dallas, TX

Gis Analyst jobs in Austin, TX

Lead Analyst jobs in Portsmouth, NH

Lead Analyst jobs in Libertyville, IL

Lead Analyst jobs in Winston Salem, NC

Healthcare Analyst jobs in Connecticut

Policy Analyst jobs in Houston, TX

Clinical Documentation Improvement Specialist jobs in Oakland, CA

Quality Improvement Specialist jobs in Philadelphia, PA

Clinical Pharmacology jobs in Remote

Clinical Documentation Improvement Specialist jobs in Gainesville, FL

Clinical Documentation Improvement Specialist jobs in Springfield, IL

Clinical Documentation Improvement Specialist jobs in Saint Paul, MN

Non Clinical Physical Therapy jobs in Remote

Lead Analyst, Payment Integrity - Health Plan

Molina Healthcare -
Oxford, MS

Apply Now

Job Details

Full-time
$59,811.00 - $129,589.63 a year

Benefits

Health insurance

Qualifications

Medicare coding guidelines
Managed care organization experience
Spreadsheets
Health insurance knowledge
Project management experience in healthcare
Centers for Medicare & Medicaid Services (CMS) billing regulations
Managing projects
Productivity software
Cross-functional collaboration
Financial data analysis tools
Cross-functional communication
Data analysis software

Full Job Description

JOB DESCRIPTION Job Summary

Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance.

Essential Job Duties

Business Leadership & Operational Ownership
Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions.
Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met.
Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight.
Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals.
Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries.

Strategic Business Analysis

Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps.
Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans.
Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
Partners with finance and compliance to develop business cases and support reporting that ties operational outcomes to financial targets.

Applied Analytical Support
Uses data analysis tools/systems to support business analysis.
Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities.
Creates succinct summaries and visualizations that enable faster leadership decision-making.

Required Qualifications

At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience.
Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.
Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.
Strong data analysis/queries experience, and ability to analyze data to inform business decisions.
Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.
Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
Strong written and verbal communication skills, including ability to synthesize complex information.
Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency.

Preferred Qualifications

Experience with Medicare, Medicaid, and/or Marketplace lines of business.
Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.
Project management experience.
Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.

Advanced Excel (formulas, Pivot Tables)

SQL and QNXT

Claims experience

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $59,811 - $129,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

coding specialist jobs in batesville ms

Lead Analyst, Payment Integrity - Health Plan

DRG Integrity Specialist

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for coding specialist in batesville ms

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected