The Sr. Analyst, Revenue Integrity, Procedural Supply Governance reflects the mission, vision, and values of Northwestern Medicine (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.
The Senior Revenue Integrity Analyst will support the Clinical Department and revenue cycle and perform charge capture analysis including annual price increase analysis. The Senior Revenue Integrity Analyst will be responsible for helping maintain the charge master to ensure compliance, accuracy, and consistency for Northwestern Medicine. The Senior Revenue Integrity Analyst will prepare analysis and support for management and the Clinical Departments.
Responsibilities:
- Perform daily maintenance and quarterly audits of the EAP.
- Prepare necessary files for the EAP database of required department builds.
- Proactively identify charge capture opportunities in all revenue producing departments.
- Research and interpret billing and coding regulations, communicate to impacted areas, and apply changes that affect policy, financial, charge capture, patient care, billing, and coding operations.
- Lead quarterly audits on the charge master data elements.
- Review departmental front-end charge capture tools for accuracy.
- Leads complex audits and prepares methodology for annual pricing changes and/or annual coding changes.
- Consistently delivers concrete, relevant results. Displays qualities of resiliency and resourcefulness while thinking strategically and practically when problem solving. In addition to results orientation, displays business knowledge, speed and decisiveness, and project management.
- Troubleshoot complex account errors and provides education for resolution to Revenue Manager(s).
- Resolve and answers questions related to charge capture and complex regulatory billing issues. (e.g. Provider-Based status rules, OPPS, CCI, MUE).
- Liaison with Revenue Cycle, IT and clinical departments to link EPIC and charge master.
- Research, compile, and analyze financial data while organizing and maintaining database files for financial modeling.
- Mentors and supports members of Revenue Integrity Team as an informal leader.
- Lead efforts to assess, modify, and/or develop and implement more timely and consistent processes/systems to increase efficiency, accuracy, and meaningfulness of information.
- Demonstrates knowledge in computer applications such as knowledge in databases, spreadsheets and word processing applications in a high complexity environment.
- Maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, adopting and implementing industry best practices, and participating in professional societies.
- Supports the finance, operations and revenue cycle teams through special projects.
- Protect operations by keeping financial and patient information confidential.
- Supports the finance operation of Northwestern Medicine.
Minimum Requirements:
Education:
Bachelor’s Degree in Business or related field or 10 years of equivalent experience with progressive advancement.
Experience:
Proficiency with Microsoft office suite
5+ years in revenue cycle or revenue integrity role
Advanced understanding of CPT, HCPCS, ICD-10, and third party billing requirements
Extensive knowledge and experience with Medicare/Medicaid regulations
Behavioral Attributes:
Strong communication, collaboration, and analytical skills
Requires critical thinking, decisive judgment, high attention to detail and ability to work with minimal supervision
Preferred:
- EPIC Certification (Resolute Charge Capture)
- EPIC Certification (Clarity Report Data)
- Master’s degree in Healthcare Management, Business, MIS, Data Analytics, or related field
- Beginner to Moderate knowledge of SQL and relational databases
- RHIA preferred or related health care credential (e.g. Radiology technician, RN)
Northwestern Medicine is an equal opportunity employer (disability, VETS) 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.
Background Check
Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.
Artificial Intelligence Disclosure
Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.
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.
Click on or copy and paste URL to your browser to view detailed benefits information https://jobs.nm.org/benefits
Please refer to the Benefits Eligibility by Employment Classification to determine benefits eligibility for job postings.
If sign-on bonus is included in a job posting eligibility is as followed: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign-on bonus. Exception: New graduate internal employees seeking their first licensed clinical position as a Registered Nurse at NM may be eligible.