Job Description

ONSITE POSITION - Not Remote

About The Villages Health

The Villages Health is a patient-centered primary care driven, multi-specialty medical group with over 800 team members. Our unique care model gives us both the time and resources to truly care for our patients, along with a company culture that supports a healthy work-life balance for our team members. Our purpose, mission and vision is to empower Villagers and the surrounding communities to live out their dreams by keeping them healthy and healing them quickly. Together, we are changing the way healthcare is delivered and are making a positive difference in the lives of our patients and the communities we serve. In doing so, The Villages Health is creating America’s Healthiest Hometown.

Our Full-time Benefits
Medical, Dental & Vision Insurance | Matching HSA & 401k | PTO & Paid Holidays | The Villages Charter School Eligibility | & much more!

Responsibilities:

Accountable for timely, accurately coding and filing claims to minimize the number of claim rejections and denials.

• Review medical records, provider notes, dictation and other documentation and compare to the actual codes selected by the provider. In accordance with correct coding guidelines, correct codes and notify provider as needed. 
• Utilize ICD9/ICD10 to code diagnosis and determine principal and significant secondary diagnoses. 
• Utilize CPT/HPCS to assign and sequence all codes for services rendered 
• Provide education and teaching to providers and clinical assistants as needed related to properly coding encounters (CPT, ICD-10 and HCC) and compliance with medical record documentation.
• Review all FFS and UHC MA notes from encounters from prior day.
• Review diagnosis codes to ensure that the codes are specific to clinical documentation properly.
• Collaborate and provide feedback to providers when questions arise where a code might need to be edited or added according to correct coding guidelines and requirements.
• Ensure that claims are accurate and clean before submission utilizing appropriate coding tools.
• Resolve coding issues in the Athena Workflow Dashboard “Hold” cues as well as the Assigned Claim Worklists . Collaborate with provider to obtain codes/information necessary to submit claims.
• Review assigned providers upcoming schedules to identify M.A. patients. Audit M.A. patient chart for any HCC diagnoses (retrospective, prospective or suspected) that need to be brought forward to the provider to validate and subsequently address.
• Comply with all legal requirements regarding coding procedures and practices.
• Conduct chart audits and coding reviews to ensure all documentation is accurate and precise in accordance with correct coding guidelines.
• Work closely with compliance and department administrators on coding and documentation issues as they arise.
• Perform and share research regarding coding issues as requested.
• Assist and collaborate with TVH billing department personnel as needed to ensure all bills are satisfied in a timely manner.
• Meet defined productivity standards (as stated below)
• Maintain currency with established coding and insurance processing guidelines.
• Attend scheduled coding meeting as well as other scheduled meetings to provide coding input.

Education/Experience Requirements:

• High school graduate, some college coursework preferred. 
• 2 years medical coding experience. 
• Experience in interpreting medical records; electronic & paper. 
• Experience in interacting with physicians regarding coding requirements. 
• CPC, CCS, CRC required. 
• Extensive knowledge of CPT/HPCS and ICD9/ICD10 coding. 
• Extensive knowledge of anatomy and physiology. 
• Knowledge of medical documentation and requirements. 
• Excellent typing and 10-key speed and accuracy. 
• Excellent organization skills. 
• Effective communication skills both written and verbal, 
• Commitment to high level of customer service. 
• Previous experience in operation of office machinery including copier, fax, computer and printer. 
• Proficiency in Microsoft products including Excel, Word, and Outlook.

Salary is commensurate with experience.

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