- Molina Healthcare (Covington, KY)
- …support for development of educational/training content and resources for clinical systems applications/platforms. Responsible for implementation and training ... care management, long-term services (LTSS), behavioral health, and other applicable clinical systems functions. Contributes to overarching strategy to provide… more
- Molina Healthcare (Covington, KY)
- …process improvements, tools, etc. * Integrates medical chart coding principles, clinical guidelines, and objectivity in performance of medical audit activities. ... Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. * Audits inpatient medical records and generates… more
- Molina Healthcare (Covington, KY)
- …instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant ... findings of a post pay clinical review. This position manages documents and prioritizes case...with UNET, Comet, Macess/CSP, or other similar claims processing systems . + Demonstrated ability to use MS Excel/Access platforms… more