The Villages Health



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|JOB TYPE: |Billing Specialist/Certified Coder |

|HOME COMPANY: |The Villages Health System, LLC |

|HOME BUSINESS UNIT: |The Villages Health                                          |

|REPORTS TO: |Care Center Manager |

|FLSA STATUS: |Non-Exempt |

|PRE-REQUISITE: |none |

|UPDATED/REVIEWED: |12/23/13    |

|FILE CODE: | |

|SCOPE OF RESPONSIBILITIES |  |

Accountable for timely and accurately filing of claims and for minimizing the number of rejections and denials.

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|ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. While this is intended to be an accurate reflection of the current job, management reserves the |  |

|right to revise the job or to require that other or different functions be performed when circumstances change or exigencies require (this includes but is | |

|not limited to emergencies, changes in personnel, workload, rush jobs, or technological developments). | |

1. Provide education and teaching to providers and clinical assistants as needed related to properly coding (ICD9/10 and HCC) an encounter

2. Review all UHC MA notes from encounters from prior day.

3. Compare the notes to the actual codes selected by the provider.

4. Review diagnosis codes to ensure that the codes are ordered properly.

5. Collaborate with providers when questions arise where a code might need to be edited or added.

6. Ensure that claims are accurate and clean before submission

7. Run 362.01 report daily by supervising provider/appointment provider to check for any charges on extenders and make corrections.

8. Check claims in “coder” and “code correct error”, collaborate with provider to obtain codes/information necessary to submit claims.

9. Review upcoming schedules for chart audit to abstaract HCC codes for Medicare Advantage patients. HCC diagnoses that have been found need to be brought up and brought to provider’s attention in a timely manner.

|EDUCATION/EXPERIENCE REQUIREMENTS |  |

High School Graduate; some college coursework preferred.

Two years’ experience and working knowledge in medical billing/coding functions of third party payer systems including Medicare and commercial insurance.

Required to keep Continuing Education Units (CEU) current.

Staying current with any changes to coding guidelines/regulations

Previous experience in operation of office machinery including a copier, fax, computer and printer. Proficiency in Microsoft products including excel, word and outlook.

Coding certification through AAPC or AHIMA; CRC and CPC certifications preferred

Knowledge of HQPAF and Hedis processes.

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|PHYSICAL DEMANDS |  |

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Requires sitting and standing associated with a normal office environment. Regularly lifts up to 10 pounds and occasionally 25 to 50 pounds. Manual dexterity using a calculator and computer on a frequent basis.

|WORK ENVIRONMENT |  |

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Position is in a well-lighted office environment.

|ACCESS TO PROTECTED HEALTH INFORMATION (PHI) |  |

WORK ENVIRONMENT

This position requires FULL access to Protected Health Information (PHI), and will adhere to HIPAA regulations regarding PHI.

Employee and supervisor have reviewed the above job description and determined that it accurately reflects the position. Employee acknowledges and agrees that he/she is qualified to perform the essential functions of the position [with] or [without] accommodation.

Employee Name:

______________________ ________________

Employee Signature Date

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