Allan Hancock College Medical Billing and Coding Certificate Program Application Period: March 15 th May 31 st, 2016

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1 Thank you for your interest in the Allan Hancock College Medical Billing Certificate Program. We are pleased that you are exploring Medical Billing as a profession. Medical Billing is a demanding discipline and the course of study is challenging as well as rewarding. The application period ends on May 31 st. A random lottery will take place in June for seating status, and an notification will be sent by June 15 th, 2016, using the address provided on this application. Please review the contents of this application packet thoroughly prior to submitting your application and supporting documents. If you have questions regarding the Medical Billing Certificate and/or specific questions about the application process contact the Health Sciences Department at ext PROGRAM The Medical Billing Certificate Program is a two-semester evening/night program that provides essential skills needed for employment in the billing department of a medical office. EMPLOYMENT OPPORTUNITIES The median hourly wage is $15.00 per hour. A medical biller may work in private practice such as a medical office. Other areas of employment include community clinics and government agencies, including federal or state hospitals. CERTIFICATION OF ACCOMPLISHMENT Total of 16 units Allan Hancock College will offer a Certificate of Accomplishment, once the student has completed the mandatory classes. 1 st semester 9 units MA-305 Body Systems and Disease 5 MA-352 MA Administrative Procedures 4 2 nd semester 7 units MA-360 Medical Billing and Insurance 4 MA-361 Coding for Medical Insurance 3 APPLICATION ELIGIBILITY CRITERIA Must complete the following classes with a grade C or better, show equivalency or currently taking the following: Eng 514 or Reading 110 Math 531 or Math 521 APPLICATION AND ADMISSION To apply for the Medical Billing and Coding Program, you must submit a completed application. Incomplete packets will not be accepted. Once the office receives your completed application, we will use a randomized lottery system that will seat 30 students. Students will be notified via ( address provided on application) as to status in the program on June 15, The student will be REQUIRED to mail or bring in the original acceptance statement for verification of acceptance in the program (please check your spam/junk ). A waitlist will only be maintained until the last day to add and will not carry over to the next application period. ** Please remember to make a copy of your entire application packet prior to turning it in. Copies will not be made at the Health Sciences Office. Copy machines can be found at the library. Student Services or at campus graphics. 1

2 COMPLETED APPLICATION CONSISTS OF: Application form Proof of completion of Math 531 or Math 521 and Eng 514 or Reading 110 OR show the course is in progress (unofficial AHC transcripts with ALL courses showing completion or in progress). If you completed one or more of these courses elsewhere, all official transcripts from other colleges must be turned in to the Admissions and Records Department. Please allow 10 business days to be transcribed in time to turn in your application. UPON ACCEPTANCE An will be sent out on June 15 th, 2016 to students seated in the upcoming class containing an acceptance letter. This acceptance letter must be completed and turned into the Health Sciences office by the specified date. It is the responsibility of the student to register and pay for all the Medical Billing and Coding classes held in each semester. FINANCIAL AID For assistance with registration fees and cost of supplies please contact the Financial Aid office (x3216) ABSENCE AND TARDY POLICY Grade points are deducted for absences in excess of two (2) per semester. Three (3) tardies are considered a full day s absence. If you are not present when role is called, you are tardy. Missing 30 minutes of class or more during ANY part of class is considered a full day s absence. Do not make appointments during class time. There is no such thing as an excused absence. MEDICAL BILLING PROGRAM ESTIMATED STUDENT FEES Fall Semester TUITION (9 $46/unit) $ PARKING $20.00 HEALTH FEE, STUDENT CENTER FEES PLUS STUDENT REPRESENTATION FEE ($19+$9+$1) $30.00 REQUIRED FALL TEXTBOOKS $ (est.) MISCELLANEOUS SUPPLIES flash drive, notebooks, pens, paper, etc. $60.00 Total is estimated $ Spring Semester TUITION (7 $46/unit) $ PARKING $20.00 HEALTH FEE, STUDENT CENTER FEES PLUS STUDENT REPRESENTATION FEE ($19+$7+$1) $30.00 REQUIRED SPRING TEXTBOOKS $ (est.) MISCELLANEOUS SUPPLIES flash drive, notebooks, pens, paper, etc. $60.00 Total is estimated $ TOTAL ESTIMATED COSTS TO ACHIEVE MEDICAL BILLING CERTIFICATE $1, Prices are subject to change 2

3 Application Deadline for this application is May 31, Applications are reviewed after the deadline. Status notification will be ed by June 15 th, Please type or print clearly. We will not accept illegible applications. This application will only be used for the Medical Billing and Coding application pool. Personal Information Full Name: Last First Middle Mailing address: Street City Zip Primary Phone # Secondary Phone# Social Security # Birth Date AHC Student # Address (Mandatory) Check boxes I have read this application packet carefully and agree to comply with the standards and rules detailed within. I understand that I must show proof of completion of pre-requisites with a grade C or better OR show proof of current enrollment. I understand that my official transcripts from ALL other colleges will be transcribed through Admissions and Records before I turn in my unofficial AHC transcripts showing completion of these pre-requisites. I understand that I will be notified by no later than June 15 th, It is my responsibility to write my clearly, and check my spam/junk mail. If given a seat, the information packet will be ed to the address I have provided. I understand that if I am in progress or currently enrolled in any of the pre-requisite classes, I will submit my grade(s) showing proof of passing with a grade C or better by they first day of class. If I am on the waitlist (maintained until the last day to add), I understand that I will be contacted via /PHONE CALL as seats become available and I may not have very much time to respond. It is my responsibility to complete the packet within the timeframe specified upon notification. I certify that the statements made in this application are true and complete to the best of my knowledge and that any false or misleading information I may give may be cause to denial of admittance Signature Date Submitting an application does not guarantee that applicants have satisfied minimum criteria You may hand deliver this application packet to the Health Sciences office (M132) on the Main Campus or mail to: Attn: Health Sciences Department, 800 S. College Drive, Santa Maria, CA by the end of the application period (May 31, 2016). Please slide under the door if the door is closed. 3

4 Confidential Applicant Survey Federal and state mandates require that we compile summary data on the gender and ethnicity of applicants. To assist us in complying with this requirement we are requesting that you complete and return this form. It should be emphasized that it is the policy of Allan Hancock Joint Community College District that no person shall be discriminated against on the basis of race, color, ancestry, religion, gender, national origin, age, physical/mental disability, medical condition, marital status, or sexual orientation, information regarding the gender and ethnicity as applicants is not supplied to any other agency and is kept in a confidential file. Supplying the following information is optional and will not affect the status of your application. Name: Date: Program Applying For: Medical Billing and Coding Program Ethnic Background and Gender (please check only one): African American Asian Pacific Islander (Filipino) Hispanic American Indian Caucasian Other Asian Pacific Islander (non-filipino) Filipino Female Male I prefer not to provide this information 4

5 For Office Use Only Last Name AHC Student # H Application and Prerequisites Completed: Completed Program Application AHC Unofficial Transcripts Eng 514 or Reading 110 completed Currently enrolled Semester Math 531 or Math 521 completed Currently enrolled Semester Notes 5