Northwestern Medicine

Artificial Intelligence

• 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

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 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

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

Financial Planning and Analysis

• 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

Financial Assessor, Patient Accounting

• 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

Anesthesia Coding Specialist II, PB Coding

Billing Coordinator, PB Coding

Coding Specialist II, PB Coding

Physical Therapist

Financial Assessor, Patient Accounting

Inpatient Coder II, HB Coding