Coding Denials Specialist

The Coding Specialist reflects the mission, vision, and values of Northwestern Medicine and complies with all relevant policies, procedures, guidelines, and regulatory and accreditation standards.

This role performs Current Procedural Terminology (CPT) and ICD-9 coding through abstraction of the medical record. The position also trains physicians and other staff on documentation, billing, and coding, while supporting related administrative and clerical functions.

Responsibilities

• Abstract and code physician professional services and diagnosis codes, including inpatient admissions, outpatient procedures, and diagnostic services.
• Assign appropriate CPT and ICD-9 codes.
• Complete coding and billing worksheets.
• Ensure charges are captured through reconciliations of procedure schedules, clinical system reports, and fatal edit reports.
• Provide documentation feedback to physicians.
• Maintain coding reference information.
• Train physicians and other staff on documentation, billing, and coding.
• Review and communicate new or revised billing and coding guidelines.
• Attend meetings and roundtables and communicate pertinent information to physicians and staff.
• Resolve pre-accounts receivable edits and monitor missed billing opportunities.
• Maintain non-compliance logs and identify recurring issues.
• Delete incorrectly billed services, add missing unbilled services, and correct CPT and ICD-9 codes and modifiers.
• Draft letters and coordinate appeals.
• Work with Revenue Cycle staff and Account Inquiry Unit staff as needed and assist in obtaining supporting documentation.
• Provide invoice disposition instruction and additional code and modifier information.
• Perform other duties as assigned.