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Physicians United Plan (PUP) is a Medicare Advantage Coordinated Healthcare Plan that also provides Prescription Drug Coverage for its members. PUP is contracted with the Center of Medicare and Medicaid Services to provide healthcare to Medicare Beneficiaries. Currently, PUP employs over 200 employees with Florida based offices in Orlando, Winter Haven, Ocala, and Weston. The company was founded in 2005 with less than one thousand members and has expanded through Florida and currently has over 22,000 members enrolled in the plan. The expansion efforts continue as PUP looks to be the industry leader in Medicare Advantage Plans by employing good people building a great company.
The Medical Coder is responsible for conducting clinical chart audits for the purpose of identifying and submitting documented diagnoses to Medicare/Medicaid for health plan members. Interacts with a variety of internal and external clients including health care executives, physicians, and provider office personnel. Offers support in the Medical Risk Adjustment department, focusing on provider education and educational material development. Assists in all the functions within the department to ensure that all of the delegated duties are processed smoothly, efficiently and effectively.
Essential Duties And Responsibilities
•Reviews high volume of medical records to determine if specific disease conditions were overlooked in billing.
•Adheres to all official coding rules and CMS guidelines for risk adjustment reporting and ensures accuracy, completeness, specificity and appropriateness of diagnosis information.
•Completes HEDIS chart review
•Completes appropriate paperwork and documentation regarding claim/encounter diagnosis information.
•Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus actual services provided to the patient.
•Performs analysis from the chart reviews for provider education training.
•Works with other members of the organization to ensure the smooth processing of the chart review functions.
•Assists in the development of educational materials.
•Provides articles for the quarterly coding newsletter.
•Performs other duties as assigned by Management.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Certificates, Licenses, Registrations
Certified Coding Specialist through AAPC, BAMC or AHIMA, specifically in ICD-9-CM and CPT Evaluation and Management coding.
Education And Experience
Associate's degree (A. A.) or equivalent from two-year College or technical school; 3 plus year related experience and/or training; or equivalent combination of education and experience.
At PUP, our Purpose is to improve our Members health and well-being, and we want the same for our employees. We offer a comprehensive health and welfare plan that provides our staff and their families with health, dental, vision care and life insurance. We also provide a 401K savings plan as well as a Flexible Savings Account (FSA) so that you can better budget your health and dependent care costs for the year. Other programs include free annual flu shots, access to a Health & Wellbeing Program, and a culture that is dedicated to ensuring that both our members and employees are provided with a high energy, positive, and fun environment.
YOU ARE PUP!