Northwestern Medicine

Compliance

• Help manage all aspects of the Compliance Hotline and compliance issues received via e-mail and phone
• Help ensure reported issues are appropriately received, evaluated, investigated, documented, and resolved
• Assist with maintaining a log/database of all issues received by the department through the compliance hotline, e-mails, phone calls, etc.
• Document all issues received, actions taken, and resolutions
• Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect NMHC and its subsidiaries
• Coordinate investigations in response to incoming compliance related issues
• Gather all relevant information for potential compliance issues, determine underlying causes, and relate information from different sources to draw logical conclusions
• Coordinate non-coding and non-billing related audits, reviews and investigations
• Perform follow-up, audits, reviews, investigations, and validations
• Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required
• Assist with the development of compliance education and training materials
• Support and assist the Corporate Compliance Manager in identifying and assessing areas of compliance risk for NMHC

RHIA Compliance Associate, II

Accounting Manager

• Responsible for providing leadership and professional expertise or services by leveraging the knowledge and skills of Patient Accounting Billing & Follow-up staff.
• Maintain oversight for timely resolution of all claim edits and management & reporting of candidates for bill.
• Outbound compliant bill submission, clinical documentation requirements and any other communication required regarding claims ensuring timely filing of claims.
• Timely follow-up and collection of third party payer receivables.

Ops Coordinator, Patient Accounting

• Help manage all aspects of the Compliance Hotline and compliance issues received via e-mail and phone
• Help ensure reported issues are appropriately received, evaluated, investigated, documented, and resolved
• Primary responsibility for auditing/reviewing provider documentation, coding, and billing to ensure that the documentation supports the CPT codes billed to government payors
• Results of the provider audits/reviews are shared with the provider
• Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements
• Work with Senior/Manager/Director on more complex issues or investigations
• Respond to queries or allegations and triage issues to appropriate departments when necessary
• Assist with maintaining a log/database of all issues received by the department through the compliance hotline, e-mails, phone calls, etc.
• Document all issues received, actions taken, and resolutions
• Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect NMHC and its subsidiaries
• Coordinate investigations in response to incoming compliance related issues
• Gather all relevant information for potential compliance issues, determine underlying causes, and relate information from different sources to draw logical conclusions
• Coordinate non-coding and non-billing related audits, reviews and investigations
• Perform follow-up, audits, reviews, investigations, and validations
• Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required
• Assist with the development of compliance education and training materials
• Assist departments in the development of corrective action plans for identified issues
• Assist with the development and implementation of the departments annual Compliance Work Plan
• Help develop and maintain compliance-related policies and procedures to ensure they are current and relevant
• Assist with providing policy-related guidance to individuals and departments
• Perform other duties assigned by the department Managers, Director, or VP, Integrity

Compliance Associate, II

Analyst

• Support and maintain assigned services and systems
• Monitor, analyze and plan upgrades
• Resolve issues while maintaining Customer Service Level Agreements
• Execute project tasks as assigned
• Analyze and provide recommendations relating to application build and functionality of systems

Application Analyst – Epic Reporting

• Support and maintain assigned services and systems
• Works with team to monitor, analyze and plan upgrades
• Monitors the production issue queue and resolves issues while maintaining Customer Service Level Agreements
• Executes project tasks as assigned
• Adheres to and enhances quality assurance standards, systems development and delivery methodologies
• Contributes to ongoing process to integrate end users requests with software functionality
• Analyzes and provides recommendations relating to application build and functionality of systems to ensure reliability for current and/or future use
• Demonstrates diagnostic skills and expertise to assist with problem determination and solution across the assigned NMHC distributed system IS environment
• Participates in on call rotation
• Contributes to the maintenance of application/technical documentation and architecture diagrams

Application Analyst

Auditor

• Collaborates with clinical documentation team in the review of inpatient accounts (with an emphasis on mortality reviews) identifying documentation improvement opportunities
• Assess DRG, PDx, secondary Dx, PCS, POA and all other components of documentation that impact quality metrics
• Consistently assures coding practices remain compliant with coding guidelines and regulations
• Continually identifies educational opportunities related to coding and documentation
• Expert educator to clinical teams and medical staff
• Identifies strategic plans that will result in a positive impact to the clinical dashboard
• Develops clinical relationships across the health system securing interdepartmental support necessary for successful implementation of education strategies assuring achievement of overall strategic targets
• Ability to multi-task a variety of audits
• Ability to analyze data and construct appropriate action plans
• Develops teaching tools to promote quality outcomes
• Is an active member of clinical and executive meetings as identified
• Advanced understanding of quality metrics for health system (Vizient, PSI, USNWR)
• Advanced understanding of clinical documentation and coding through the lens of local and national quality and ranking methodologies, including but not limited to, U.S News and World Report, Vizient, Leapfrog, the CMS Star Rating, and payer contracts and assists the Managers of Clinical Documentation and Coding in implementing key strategies to effect change.
• Partners with Coding, Clinical Documentation leadership and Medical Directors to coordinate, maintain, and execute advanced project work that includes but, is not limited to, Mortality Review, HAC/PSI Review, Quality Abstraction and Analysis, and/or special and non-traditional project work.
• Partners with NM departments that includes but is not limited to: IT; Analytics; and Innovation to design and implement new and advanced workflow solutions.
• Partners with third-party consultants/partners to contribute to workflow and methodology build and refine as necessary.

Coding Quality Auditor, Specialist

• Reflects the mission, vision, and values of Northwestern Memorial
• Adheres to the organization’s Code of Ethics and Corporate Compliance Program
• Complies with all relevant policies, procedures, guidelines, and regulatory standards
• Utilizes technical coding expertise to assign appropriate ICD-10-CM and CPT-4 codes
• Reviews the medical record thoroughly to code appropriate diagnoses and procedures
• Collaborates with Patient Accounting, Registration, case managers, and clinical areas
• Interprets health record documentation using knowledge of anatomy and medical terminology
• Follows ICD-10-CM Official Guidelines for Coding and Reporting to select appropriate codes
• Resolves NCCI, NCD/LCD or other claim failures as assigned
• Meets established minimum coding productivity and quality standards

Coding Analyst

Financial Planning and Analysis

• Financial Assessor Patient Accounting reflects the mission, vision, and values of NM
• Consistently meet the current productivity and quality standards in timely resolution of all claim edits
• Reporting of candidates for bill
• Outbound compliant claim submission
• Clinical documentation requirements
• Timely follow-up and collection of third party payer receivables
• Denials and Appeals follow-up including root cause analysis to reduce/prevent future denials
• Compliant follow-up correspondence to third party payers regarding outstanding accounts receivables
• Support the operations related to optimum third party accounts receivables
• Perform daily, systematic reviews of work lists to ensure all accounts already to be worked are completed
• Recommend accounts for contractual or administrative write-off and provide appropriate justification and documentation
• Practice HIPAA privacy standards and ensure compliance with patient health information privacy practices
• Identify opportunities for customer, system and process improvement and submit to management

Financial Assessor, Patient Accounting

Artificial Intelligence

• Consistently practices Patients First philosophy and adheres to high standards of customer service
• Responds to questions and concerns and forwards/escalates extraordinary issues to Team Lead or Operations Coordinator
• Maintains patient confidentiality per HIPAA regulations
• Provides exceptional customer service to patients and establishes a positive first impression of Northwestern Medicine
• Correctly identifies and collects patient demographic information in accordance with organization standards
• Interacts with hospital departments and physician offices to schedule and direct patients through NMHC systems
• Reaches out to patients to schedule appointments and performs medical necessity checks
• Informs patients of issues securing financial account for their encounter and completes out-of-pocket estimations
• Provides training and education as needed and acts as a training resource for new staff
• Manages work schedule efficiently and completes assigned tasks on time; cross-trains between departments
• Participates in Quality Assurance reviews to ensure integrity of patient data
• Uses effective service recovery skills to solve problems or service breakdowns
• Utilizes department and hospital policies and procedures and avoids putting patient in financial or safety risk
• Communicates about physician referrals, insurance referrals, and consultations; collects authorization numbers as applicable
• Communicates across units/departments, resolves operational issues, and supports internal customers
• Utilizes multiple online systems to verify/print orders and verifies insurance eligibility and benefits (NDAS, ASF, RTE, Epic)
• Sends quality Epic Messages/Telephone encounters and documents order retrieval and handoff instructions
• Proactively prevents issues with patient visits, analyzes account activity, suggests process improvements, and monitors registration/scheduling to meet quality standards

Patient Access Specialist

• Utilizes technical coding expertise to assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types
• Utilizes technical coding expertise to assign Evaluation and Management codes for physician encounters
• Reviews the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses, procedures, and evaluation and management services
• Collaborates with Patient Accounting, Registration, case managers, and other clinical areas to provide coding reimbursement expertise
• Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to report appropriate diagnoses and/or procedures
• Follows ICD-10-CM Official Guidelines for Coding and Reporting, Coding Clinic, Coding Clinic for HCPCs, CPT Assistant, interprets coding conventions and instructional notes to select appropriate diagnoses and procedures with a minimum of 95% accuracy
• Resolves NCCI, NCD/LCD or other outpatient edit claim failures as assigned
• Meets established minimum coding productivity and quality standards for each outpatient encounter type
• Other duties as assigned

• Assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types
• Review medical records thoroughly using available documentation
• Interpret health record documentation using anatomy, physiology, clinical disease process, pharmacology, and medical terminology
• Send physician queries when required for documentation clarification
• Follow Coding Clinic for HCPCs, CPT Assistant, and interpret coding conventions and instructional notes
• Provide technical expertise to analyze system related changes and participate in testing of software modifications
• Identify opportunities to enhance CAC (computer assisted coding)
• Resolve NCCI Edits with approved hospital modifiers
• Utilize 3M Encoder resources to ensure optimal coding accuracy
• Meet established minimum coding productivity (90%) and quality standards (95%) for each outpatient encounter type

Outpatient Coder II, HB Coding

• Performs CPT and ICD10 coding through abstraction of the medical record with a focus on Evaluation and Management services
• Utilizes technical coding expertise to review the medical record thoroughly and assign appropriate CPT, ICD10 codes and modifiers
• Provides documentation feedback to physicians and trains physicians and other staff regarding documentation, billing and coding
• Reviews and communicates new or revised billing and coding guidelines and attends meetings and educational roundtables
• Resolves pre-accounts receivable edits and Optum coding edits; makes appropriate changes to incorrectly billed services and adds missing unbilled services
• Identifies and reports repetitive documentation problems and system issues
• Collaborates with Patient Accounting, PB Billing, Revenue Cycle and Account Inquiry Unit staff to provide coding reimbursement assistance and resolve claim issues
• Meets established minimum coding productivity and quality standards and may perform other duties as assigned

Coding Specialist I, PB Coding

• Assign ICD-10-CM and ICD-10-PCS codes to complex inpatient discharges
• Assign Present on Admission (POA) values to secondary diagnoses
• Review provider notes and Clinical Documentation Improvement findings
• Use CAC software to review documentation and select codes
• Review Discharge Planning and nursing documentation for Discharge Disposition
• Utilize knowledge of MS-DRG, APR-DRG, AHRQ Elixhauser to sequence codes
• Collaborate with CDI on ~45% of discharges
• Educate CDI on regulatory guidelines and Coding Clinics
• Interpret documentation to determine Principal and secondary diagnoses and procedures
• Write appeal letters in response to payor DRG downgrade notices
• Resolve Nosology Messages/Alerts and Coding Validation Warnings/Errors
• Meet established coding productivity and quality standards

Inpatient Coder II, HB Coding

• Assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types
• Assign Evaluation and Management codes for physician encounters
• Review medical records thoroughly using all available documentation to code diagnoses, procedures, and E/M services
• Resolve NCCI, NCD/LCD or other outpatient edit claim failures as assigned
• Collaborate with Patient Accounting, Registration, case managers, and other clinical areas to provide coding reimbursement expertise
• Interpret health record documentation to report appropriate diagnoses and/or procedures
• Follow ICD-10-CM Official Guidelines for Coding and Reporting and other coding references
• Meet established minimum coding productivity and quality standards for each outpatient encounter type
• Other duties as assigned

Therapist

• Provide direct patient care via telehealth as part of Northwestern Medicine’s telemedicine physical therapy expansion
• Maintain primary responsibility over patient plan of care from initial contact to discharge
• Perform evaluations, re-evaluations, progress notes, and discharge summaries in the EMR
• Collaborate with treating PTs and PTAs and communicate effectively with healthcare team members (physicians, nurses, case managers)
• Teach and mentor clinical interns and participate in student clinical/observation programs
• Participate in committees, department processes, internal and external marketing, and special projects
• Contribute to continuous improvement, cost reduction, and service growth efforts
• Use effective service recovery skills and provide patient education appropriate to patient understanding
• Maintain productivity standards and be willing to flex schedule or assignment to meet patient care needs

Physical Therapist

• Performs CPT and ICD10 coding through abstraction of the medical record with focus on more complex encounters and/or HCPCs procedural codes
• Reviews the medical record thoroughly and codes physician professional services and diagnosis codes including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters
• Follows Official Guidelines and rules to assign CPT, ICD10 codes and modifiers with minimum 95% accuracy
• Ensures charges are captured by performing various reconciliations
• Provides documentation feedback to physicians and trains physicians and other staff regarding documentation, billing and coding
• Reviews and communicates new or revised billing and coding guidelines
• Resolves pre-accounts receivable edits and collaborates with Patient Accounting, PB Billing, and other operational areas
• Acts as key point person for Revenue Cycle staff and Account Inquiry Unit staff in obtaining documentation
• May contact providers for peer-to-peer reviews
• Meets established minimum coding productivity and quality standards

Coding Specialist II, PB Coding

Billing Specialist

• Coordinate timely and accurate professional billing for Northwestern Medicine
• Remain up to date regarding company-wide and industry billing and coding changes
• Review encounter documentation to confirm reported services
• Resolve pre-bill edits to confirm correct coding (modifier, diagnosis, CPT, and HCPCS review)
• Educate providers on correct coding and documentation guidelines
• Utilize coding resources to facilitate correct coding
• Triage provider and practice administration queries
• Request necessary charge corrections
• Perform administrative activities and projects and attend team/department meetings
• Perform various administrative and clerical duties to support the role’s core function

Billing Coordinator, PB Coding

• Performs CPT and ICD10 coding through abstraction of the medical record with a focus on more complex encounters and/or expertise with HCPCs procedural codes.
• Reviews anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters and codes appropriately.
• Assigns appropriate CPT, ICD10 codes and modifiers with a minimum of 95% accuracy.
• Ensures charges are captured by performing various reconciliations (procedure schedules, OR logs and clinical system reports).
• Provides documentation feedback to physicians and trains physicians and other staff regarding documentation, billing and coding.
• Reviews and communicates new or revised billing and coding guidelines and information; attends meetings and educational roundtables.
• Resolves pre-accounts receivable edits and identifies repetitive documentation problems and system issues.
• Collaborates with Patient Accounting, PB Billing, and other operational areas to provide coding reimbursement expertise and assist with appeals.
• Acts as key point person for Revenue Cycle staff and Account Inquiry Unit staff in obtaining documentation and provides additional code and modifier information to assist with appealing denials.
• Meets established minimum coding productivity and quality standards for each encounter type.
• May perform other duties as assigned.

Anesthesia Coding Specialist II, PB Coding

• Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types
• Assigns Present on Admission (POA) values to all secondary diagnoses for quality metrics and reporting
• Thoroughly reviews provider notes and findings from Clinical Documentation Improvement (CDI) nurses
• Utilizes resources within CAC software to review documentation and select or assign ICD-10-CM/PCS codes using autosuggestion or annotation features
• Reviews Discharge Planning and nursing documentation to validate and correct Discharge Disposition affecting reimbursement
• Utilizes knowledge of MS-DRG, APR-DRG, AHRQ Elixhauser risk adjustment to sequence ICD-10-CM codes within top 24 fields
• Collaborates with CDI on approximately 45% of discharges regarding final MS or APR DRG and comorbidity diagnoses
• Educates CDI on regulatory guidelines, Coding Clinics and conventions
• Interprets health record documentation to determine Principal Diagnosis, secondary diagnoses and procedures
• Follows ICD-10-CM and ICD-10-PCS Official Guidelines, Coding Clinic guidance, coding conventions and instructional notes
• Writes appeal letters in response to payor DRG downgrade notices
• Resolves Nosology Messages/Alerts and Coding Validation Warning/Errors
• Meets established coding productivity and quality standards

• Consistently meet productivity and quality standards in timely resolution of claim edits and reporting
• Ensure timely filing of clean, complete, and accurate claims and outbound compliant claim submission
• Timely follow-up and collection of third party payer receivables
• Denials and appeals follow-up including root cause analysis and overturning denials for payment resolution
• Compliant follow-up correspondence to third party payers (Statements, letters, e-mails, faxes, portal mail)
• Support operations for third party accounts receivables across Managed Care, Commercial, Medicare, Medicaid, Workers Comp, Corporate Accounts, Research, and Specialty AR Accounts
• Perform daily systematic reviews of work lists to complete accounts ready to be worked
• Utilize government, commercial, and regulatory guidelines for collection of outstanding accounts
• Recommend accounts for contractual or administrative write-off with justification and documentation
• Practice HIPAA privacy standards and ensure patient health information privacy compliance
• Contribute to department accounts receivable goals and identify process improvement opportunities
• Follow NMHC policies, Departmental procedures, and regulatory rules (Joint Commission)
• Utilize assigned menus/pathways in hospital mainframe and external software; report software/hardware problems
• Participate in testing for assigned software applications and verify field integrity
• Assist Patient Accounting Operational Coordinator and Team Lead with special projects and attend training/seminars as assigned