Sr. Analyst, Revenue Integrity, Procedural Supply Governance

Northwesternmedicine; EUA; Presencial; USD 90 000 - 120 000; Tempo integral

Resumo da oferta

Northwestern Medicine is seeking a Senior Revenue Integrity Analyst to support clinical departments and revenue cycle with charge capture analysis and annual pricing/coding changes. You will maintain the charge master, coordinate EPIC linkage, and mentor team members while interpreting billing regulations and driving process improvements.

The role requires 5+ years in revenue integrity, CPT/HCPCS/ICD-10 expertise, and EPIC familiarity; a Bachelor’s in business or related field is expected, with

Qualificações

• Bachelor's degree or 10 years of equivalent experience with progressive advancement.
• 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 of Medicare/Medicaid regulations
• 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 files for the EAP database builds.
• Identify charge capture opportunities across revenue departments.
• Research and interpret billing regulations and apply changes to policy and operations.
• Lead quarterly audits of charge master data elements.
• Review departmental front-end charge capture tools for accuracy.
• Lead efforts to develop timely, consistent processes to increase efficiency and accuracy.
• Mentor Revenue Integrity Team members and support leadership.
• Collaborate with Revenue Cycle, IT, and clinical departments to link EPIC with charge master.
• Maintain and analyze financial data for modeling and decision making.

Conhecimentos

Strong communication

Analytical skills

Collaboration

Critical thinking

Formação académica

Bachelor's Degree in Business or related field

RHIA preferred

Ferramentas

SQL

EPIC Certification (Resolute Charge Capture)

EPIC Certification (Clarity Report Data)

Microsoft Office Suite

Descrição da oferta de emprego

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