Sr. Analyst, Revenue Integrity, Procedural Supply Governance

Northwestern Medicine; EE. UU.; A distancia; USD 55.000 - 80.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Tuition Reimbursement

Student Loan Repayment

Professional Development

Wellbeing Fund

Matching 401(k)

Medical/Dental/Vision coverage

Life insurance

Annual salary increase and incentive

Paid time off and holidays

Descripción de la vacante

Northwestern Medicine is seeking a Senior Revenue Integrity Analyst to support the Clinical Department and revenue cycle with charge capture analysis, maintaining the charge master for accuracy and compliance, and preparing management-ready analyses.

The role involves leading audits, identifying opportunities, interpreting CPT/HCPCS/ICD-10 rules, collaborating with IT to link EPIC to the charge master, and mentoring the Revenue Integrity Team while upholding regulatory standards.

Formación

• Bachelor’s Degree in Business or related field or 10 years of equivalent experience.
• 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.
• Strong communication, collaboration, and analytical skills.
• Requires critical thinking, decisive judgment, high attention to detail and ability to work with minimal supervision.
• EPIC Certification (Resolute Charge Capture) and EPIC Certification (Clarity Report Data) preferred.
• Master’s degree in Healthcare Management, Business, MIS, Data Analytics, or related field.
• Beginner to Moderate knowledge of SQL and relational databases.
• RHIA or related health care credential preferred.

Responsabilidades

• 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.
• Lead efforts to assess, modify, and/or develop and implement more timely and consistent processes/systems to increase efficiency, accuracy, and meaningfulness of information.
• Liaison with Revenue Cycle, IT and clinical departments to link EPIC and charge master.
• Mentors and supports members of Revenue Integrity Team as an informal leader.

Conocimientos

5+ years in revenue cycle or revenue

Advanced CPT/HCPCS/ICD-10 knowledge

Medicare/Medicaid regulations

Strong communication and analytical

Critical thinking and detail-oriented

Educación

Bachelor’s Degree in Business or related field

RHIA or related health care credential

Master’s degree in Healthcare Management, Business, MIS, Data Analytics, or related field

Herramientas

Microsoft Office

EPIC Certification (Resolute Charge Capture)

EPIC Certification (Clarity Report Data)

SQL (beginner to moderate)

Descripción del empleo

Sr. Analyst, Revenue Integrity, Procedural Supply Governance

Location Remote work from Illinois, Wisconsin, Indiana, and Iowa

Type of Employment Full-Time

Hours Per Week / FTE 40 hrs/wk - 1.0 FTE

The salary range for this position is $40.22 - $58.32 (Hourly Rate)

Placement within the salary range is dependent on several factors such as relevant work experience and internal equity. For positions represented by a labor union, placement within the salary range is guided by the rules outlined in the collective bargaining agreement.

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(opens in new window) section located at jobs.nm.org/benefits to learn more.

Northwestern Medicine is powered by a community of colleagues who are purpose-driven and committed to our mission to deliver world-class care. Here, you’ll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine.

We recognize where you’ve been, and we support where you’re headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and culture of service.

Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment.

Create the life you envision for yourself with flexible work options, a Reimbursable Well-Being Fund and a Total Rewards package that support your physical, mental, emotional, and financial well-being.

Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce-led resource groups.

From discovery to delivery, come help us shape the future of medicine.

Benefits

• $10,000 Tuition Reimbursement per year ($5,700 part-time)
• $10,000 Student Loan Repayment ($5,000 part-time)
• $1,000 Professional Development per year ($500 part-time)
• $250 Wellbeing Fund per year ($125 for part-time)
• Matching 401(k)
• Excellent medical, dental and vision coverage
• Life insurance
• Annual Employee Salary Increase and Incentive Bonus
• Paid time off and Holiday pay

Description

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.

Qualifications

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)