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Operations Coordinator, Coding Specialist
2 months ago
The Operations Coordinator, PB Coding plays a vital role in reflecting the mission, vision, and values of Northwestern Memorial Healthcare, adhering to the organization's Code of Ethics and Corporate Compliance Program, and complying with all relevant policies, procedures, guidelines, and regulatory standards.
Key Responsibilities- Performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record with a focus on more complex encounters and/or has expertise with HCPCs procedural codes.
- Has a deep understanding of disease process, anatomy, and pharmacology.
- Acts as a key collaborator with Providers and Clinical areas to ensure the medical record accurately reflects the patient's service.
- Trains physicians and other staff regarding documentation, billing, and coding, and performs various administrative and clerical duties to support the role's core function.
- Utilizes technical coding expertise to review 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.
- Collaborates 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 a 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.
The ideal candidate will have a deep understanding of disease process, anatomy, and pharmacology, and will be able to perform Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record with a focus on more complex encounters and/or have expertise with HCPCs procedural codes.
