Sr. Analyst, Revenue Integrity, Procedural Supply Governance

About the role

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)

Additional Information

Background Check

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.
• 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.