Northwestern Medicine

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

Analyst

• Assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types
• Assign Evaluation and Management codes for physician encounters
• Review the medical record thoroughly and code appropriate diagnoses, procedures, and evaluation and management services
• Collaborate with Patient Accounting, Registration, case managers, and other clinical areas to provide coding reimbursement expertise
• Interpret health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to report appropriate diagnoses and/or procedures
• Follow ICD-10-CM Official Guidelines for Coding and Reporting and maintain a minimum of 95% coding accuracy
• Resolve NCCI, NCD/LCD or other outpatient edit claim failures as assigned
• Meet established minimum coding productivity and quality standards for each outpatient encounter type

Coding Analyst, Part Time

Medical Billing and Coding

• Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code 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 in order to assign 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.
• Maintains coding reference information.
• 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, communicates pertinent information to physicians and staff.
• Resolves pre-accounts receivable edits. Identifies repetitive documentation problems as well as system issues.
• Makes appropriate changes to incorrectly billed services, adds missing unbilled services, provides missing data as appropriate, corrects CPT and ICD9 codes and modifiers. Adds MBO tracking codes as needed.
• Collaborate with Patient Accounting, PB Billing, and other operational areas to provide coding reimbursement expertise; helps identify and resolve incorrect claim issues and is responsible for drafting letters in order to coordinate appeals.
• Acts as key point person for Revenue Cycle staff and Account Inquiry Unit staff in obtaining documentation (notes, operative reports, drug treatment plans, etc.). Provides additional code and modifier information to assist with appealing denials. May contact providers for peer-to-peer reviews.
• Meets established minimum coding productivity and quality standards for each encounter type.
• May perform other duties as assigned.

Coding Specialist II, PB Coding

Therapist

• Provide direct patient care via telehealth
• Maintain communication with treating PT/PTAs
• Participate in departmental committees and processes
• Demonstrate NM values in daily work and interactions

Physical Therapist – Telehealth

Salesforce Administrator

• Ensure reliable, high-quality support for Salesforce and related applications
• Provide advanced expertise in configuration, maintenance, optimization, and enhancement of Salesforce
• Lead complex system initiatives and advise on architectural decisions
• Monitor system performance and analyze complex issues
• Oversee testing and implementation of changes
• Mentor junior team members
• Contribute to continuous improvement, governance, and best practices within an agile environment

Senior Salesforce Administrator

Coding Quality Auditor and Specialist

• Abstracts and codes physician professional services and diagnosis codes
• Assigns appropriate CPT and ICD9 codes
• Completes coding and billing worksheet
• Ensures charges are captured by performing various reconciliations
• Provides documentation feedback to physicians
• Maintains coding reference information
• Trains physicians and other staff regarding documentation, billing and coding
• Reviews and communicates new or revised billing and coding guidelines

Coding Specialist, Bronchoscopy

• Performs Current Procedural Terminology (CPT) and International Classification of Diseases coding through abstraction of the medical record.
• Trains physicians and other staff regarding documentation, billing and coding.
• Performs various administrative and clerical duties to support the role’s core function.
• Ensures charges are captured by performing various reconciliations.