Senior Analyst, Revenue Integrity, Procedural Supply Governance

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Assist the Clinical Department alongside the revenue cycle operations.

• Conduct analysis for charge capture, which includes evaluating annual price increases.

• Ensure the charge master is maintained for compliance, accuracy, and uniformity.

• Provide analyses and support for management and Clinical Departments.

• Carry out daily maintenance of the EAP and perform quarterly audits.

• Prepare necessary files for the development of the EAP database within the department.

• Identify opportunities for charge capture within revenue-generating departments.

• Investigate and interpret billing and coding regulations, communicating changes to relevant areas.

• Oversee quarterly audits of charge master data components.

• Evaluate front-end charge capture tools within departments for accuracy.

• Lead intricate audits and devise methodologies for annual pricing and coding updates.

• Address complex account discrepancies and guide Revenue Managers on resolutions.

• Answer inquiries related to charge capture and intricate regulatory billing issues, including Provider-Based status rules, OPPS, CCI, and MUE.

• Collaborate with Revenue Cycle, IT, and clinical departments to integrate EPIC with the charge master.

• Research, gather, and analyze financial data while maintaining database files for financial modeling.

• Mentor and provide informal leadership to the Revenue Integrity Team members.

• Evaluate, modify, develop, and implement processes and systems to enhance efficiency, accuracy, and relevance of information.

• Keep up-to-date with professional and technical knowledge through workshops, publications, networks, best practices, and professional societies.

• Assist finance, operations, and revenue cycle teams with special projects.

• Safeguard confidential financial and patient information.

• Contribute to the finance operations at Northwestern Medicine.

⛳️ Requirements

• Bachelor’s Degree in Business or a related field, or 10 years of equivalent progressive experience.

• Proficient in Microsoft Office Suite.

• At least 5 years of experience in a revenue cycle or revenue integrity position.

• Advanced knowledge of CPT, HCPCS, ICD-10, and third-party billing requirements.

• In-depth experience with Medicare/Medicaid regulations.

• Excellent communication, collaboration, and analytical abilities.

• Strong critical thinking skills, decisive judgment, high attention to detail, and capability to work with minimal supervision.

• EPIC Certification in Resolute Charge Capture is preferred.

• EPIC Certification in Clarity Report Data is preferred.

• A Master’s degree in Healthcare Management, Business, MIS, Data Analytics, or a related field is preferred.

• Basic to intermediate knowledge of SQL and relational databases is preferred.

• RHIA or similar healthcare credential is preferred.

• Must undergo a criminal history background check if selected for the position.

• Must adhere to relevant policies, regulations, accreditation standards, and Illinois healthcare worker background-check requirements.

🏝️ Benefits

• Competitive benefits package.

• Tuition reimbursement opportunities.

• Loan forgiveness options.

• 401(k) matching contributions.

• Lifecycle benefits.

• Resources for employee physical, emotional, and financial well-being.

• Protection against unexpected life events.