Job Description
The Financial Coding Specialist reflects the mission, vision, and values of NM, 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.
Responsible for the translation of diagnoses and diagnostic/therapeutic procedures into codes using the International Classification of Diseases and Procedures and the Current Procedural Terminology systems. Generates accurate claims to insurance companies, verifying that infusion documentation and charges coordinate and appropriate modifiers are added. Researches and resolves all inquiries from Revenue Cycle Departments in an efficient manner.
Responsibilities:
- 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.
- Participates in efforts to reduce costs, streamline work processes, improve and grow services we provide.
- 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 with a minimum of 95% accuracy.
- Manages the financial processes within Oncology
- Conducts nurse/MD documentation QA, monitors trends and educates nurses and MDs on necessary coding and documentation
- Processes edit and information requests from Coding Department and collaborates with Patient Financial Services and Financial Counselor to resolve oncology patient account issues. This will include checking the Team Site and Global Scan lists and providing missing documentation.
- Updates and develops charge master in conjunction with Patient Accounts.
- Assists with and provides back up for physician billing, coding, and medical necessity checks for diagnositic and therapeutic treatments ordered.
- Communicates with physicians, nurses and pharmacy in a professional, tactful manner in order to obtain missing documentation or to clarify existing unclear documentation.
- Effectively communicates with registration staff to resolve any issuses that arise.
- Provides constructive feedback to Practice Administrator, nurses and physicians regarding results of QA and audits to decrease recurring problems with documentation that may impact charge capture or coding.
- Communicates effectively with all hospital and CDPG departments assisting with oncology revenue cycle.
- Remains updated on ICD-9 and CPT changes and usage.
- Appropriately utilizes the functionality of EPIC, CareManager, and other PMS systems within their job responsibilities.
- Embraces an open and positive attitude about new technology and process to improve workflow.
- Performs other duties as assigned
Qualifications
Required:
- Six months coding experience in an oncology setting. 2 years of physician and/or hospital billing including infusion billing.
- Thorough understanding of Medicaid, HMO's, PPO's and private insurance companies.
- ICD9, CPT, and chemotherapy infusion billing knowledge.
- Effective in identifying and analyzing problems.
- Generates alternatives and possible solutions.
- Above average keyboarding and data entry skills.
- Ability to multi-task and work in a fast-paced environment.
- Ability to work with physicians and other staff in a collaborative manner.
Preferred:
- Associate's degree or CCSP.
- CERT CODER
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.
If we offer you a job, we will perform a background check that includes a review of any criminal convictions. A conviction does not disqualify you from employment at Northwestern Medicine. We consider this on a case-by-case basis and follow all state and federal guidelines.
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.
