Medical Billing and Coding

• Assess documentation content for hospital and professional services to accurately code principal diagnoses, secondary conditions, procedures, social determinant codes, and drug administration
• Assign codes for multiple encounters or sessions across hospital and professional lines of business on the same date and place of service
• Meet monthly production and quality requirements for procedures and surgeries assigned CPT codes
• Apply code sequencing according to payer-specific rules
• Analyze high-risk encounters for accurate charge capture and identify charge gaps before encounter completion
• Incorporate payer-specific billing trends into daily reviews to reduce take backs
• Facilitate clinical documentation modifications through concurrent interaction to support the level of service rendered
• Code hospital and professional sessions as part of daily work
• Retrieve order diagnosis, patient type, and related information from the hospital information system

Inpatient Hospital Coder

• Assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types
• Review medical records and available documentation to code diagnoses and procedures
• Interpret documentation using anatomy, physiology, clinical disease process, pharmacology, and medical terminology knowledge
• Send physician queries for documentation clarification
• Follow Coding Clinic for HCPCS, CPT Assistant, coding conventions, and instructional notes
• Maintain minimum 95% coding accuracy
• Meet minimum coding productivity and quality standards, including 90% productivity and 95% quality
• Provide technical expertise for system changes and participate in software modification testing
• Identify opportunities to enhance computer-assisted coding
• Resolve NCCI edits with approved hospital modifiers
• Use 3M Encoder resources to ensure coding accuracy
• Articulate rationale for coding selections when necessary

Outpatient Coder II, HB Coding

• Manage billing and accounts receivable for Pennsylvania Workers’ Compensation claims
• Perform consistent follow-up on outstanding, unpaid, and underpaid Workers’ Compensation claims
• Communicate with insurance carriers, third-party administrators, adjusters, nurse case managers, and other claim representatives to resolve outstanding balances
• Review payments and remittance documentation for accuracy and identify inappropriate reductions, denials, and underpayments
• Research and resolve denied or rejected bills involving claim information, authorization, compensability, documentation, coding, and billing requirements
• Prepare and submit reconsiderations, appeals, corrected bills, and supporting documentation
• Identify discrepancies between billed charges, expected reimbursement, and actual payments
• Maintain accurate account notes documenting collection activity and follow-up
• Work Workers’ Compensation aging reports systematically and prioritize accounts requiring immediate action
• Obtain and verify claim information, including carrier/TPA, adjuster information, claim numbers, dates of injury, and authorization information
• Identify recurring denial and payment trends and escalate systemic issues to management
• Collaborate with coding, authorization, clinical, and front-end teams to resolve reimbursement issues
• Maintain consistent account follow-up and meet established productivity and A/R performance expectations

Workers’ Compensation Medical Billing Specialist

• Assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types
• Thoroughly review medical records and available documentation to code diagnoses and procedures
• Interpret health record documentation using anatomy, physiology, clinical disease process, pharmacology, and medical terminology knowledge
• Send physician queries when documentation clarification is required
• Follow Coding Clinic for HCPCS, CPT Assistant, coding conventions, and instructional notes
• Maintain at least 95% coding accuracy
• Meet departmental minimum coding productivity and quality standards, including 90% productivity and 95% quality for each outpatient encounter type
• Analyze system-related changes and participate in testing software modifications
• Identify opportunities to enhance computer-assisted coding (CAC)
• Resolve NCCI edits using approved hospital modifiers
• Use 3M Encoder resources to optimize coding accuracy
• Articulate rationale for coding selections when required by data quality audits
• Adhere to Northwestern Medicine’s mission, values, Code of Ethics, Corporate Compliance Program, policies, procedures, regulatory requirements, and accreditation standards