Northwestern Medicine

Artificial Intelligence

• 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

Analyst

• 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

Coding Analyst

• 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