Job Description
The Laboratory Coding Analyst reflects the mission, vision, and values of Northwestern Memorial, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
The Laboratory Coding Analyst is responsible for the claim edits on laboratory charges regarding both CCI and MUE edits.
Responsibilities:
- Completes and enforces all necessary policies and procedures in regards to billing.
- Creates and enforces work standards, quality measures and process improvements, consistent with the organization's goals and objectives.
- Enforces safeguards against fraud and abuse.
- Ensures compliance for adjustments posted to accounts according to departmental policies and filing guidelines.
- Uses organizational and unit/department resources efficiently.
- Manages work schedule efficiently, completing tasks and assignments on time.
- Contributes to opportunities and processes for continuous improvement.
- Demonstrates Integrity, Compassion, Accountability, Respect and Excellence values in daily work and interactions.
- Presents a friendly, approachable, professional demeanor and appearance.
- Provides accurate information and timely updates to patients and customers.
- Addresses questions and concerns promptly,or identifies appropriate person and resources to do so.
- Provides directions or help to patients and customers with finding their way.
- Demonstrates teamwork by helping co-workers within and across departments.
- Communicates effectively with others, respects diverse opinions and styles, and acknowledges the assistance and contributions of others.
- Creates a positive learning environment when instructing new employees, presents information clearly, concisely and at an appropriate pace.
- Shows attention to detail, uses reasoning skills and is sufficiently organized to produce quality work.
- Other duties assigned.
Other Role Specific Responsibilities:
- Follows Standards of Ethical Coding as established by the AHIMA Code of Ethics.
- Reviews the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures.
- Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to identify codeable diagnoses and/or procedures.
- Interprets conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses and procedures that require coding.
- Assigns codes in accordance with official coding guidelines and resources and specific facility guidelines.
- Abstracts required data elements with accuracy.
- Contributes to department goal of maintaining low ANSB by following guidelines for bill hold flags, monitoring personal and work queues to code oldest accounts first, reassignment of problem accounts, etc.
- Ensure accuracy all claims billed through the verification of key data on the UB-04.
- Obtain all supporting documentation for any hard copy claims.
- Inclusive of but not limited to; a copy of the fee schedule, contracts, physician documentation, etc.
- Serves as contact person for inquiries and help with resolution for charges.
- Document all follow up activity in the patient accounting system.
- Obtain and submit additional information needed to get the claim resolved.
- Identifies recurring charge issues that impact charging accuracy.
- Attends staff meetings to provide feedback to staff on documentation issues that create charging issues.
- Works independently at an established productivity level.
- Demonstrate a working knowledge of patient type which is billed by the hospital and by HealthLab.
- Professional Responsibility:
- Completes all required educational/compliance-related courses prior to or on the due date.
- Keeps reporting staff current with all required educational/compliance-related courses prior to or on the due date.
- AA/EOE.
Qualifications
Required:
- Certification as a RHIT, RHIA, CPCH, CCS or CCS-P.
- 2 years clinical laboratory experience or 4 years experience in a healthcare billing role.
- High School diploma with minimum 5 years experience in a hospital billing setting.
- 2-4 years billing experience.
Preferred:
- 2 + years of clinical lab technology testing experience.
- Bachelor of Science preferably MT/Associate of Science preferably MLT or equivalent.
- 5+ years of billing experience.
- Expert knowledge of Horizon, EPIC, and Seacost billing systems.
- Expert understanding of client billing.
Additional Information
Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
Benefits
We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.
