At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?
The Senior Analyst, Revenue Integrity reflects the mission, vision, and values of 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.
- 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).
- Resolves 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.
- Bachelor's Degree in Business or related field or 10+ years of equivalent experience with progressive advancement.
- Strong communication, collaboration, and analytical skills.
- Proficiency with Microsoft office suite.
- 5+ years in revenue cycle or revenue integrity role.
- Requires critical thinking, decisive judgment, high attention to detail and ability to work with minimal supervision.
- Advanced understanding of CPT, HCPCS, ICD-10, and third-party billing requirements.
- Extensive knowledge and experience with Medicare/Medicaid regulations.
- 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 affirmative action/equal opportunity employer 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.