Senior Analyst, Revenue Integrity, Procedural Supply Governance

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

📋 Description

• Provide support to Clinical Departments and the revenue cycle.

• Conduct charge capture analysis, including evaluations of annual price increases.

• Ensure compliance, accuracy, and consistency by maintaining the charge master.

• Prepare analyses and offer support for management and Clinical Departments.

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

• Organize files for the necessary EAP database department builds.

• Identify charge capture opportunities within revenue-generating departments.

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

• Oversee quarterly audits of charge master data elements.

• Review front-end charge capture tools used by departments for accuracy.

• Lead intricate audits and develop methodologies for annual pricing and coding modifications.

• Address complex account errors and educate Revenue Managers on resolution strategies.

• Resolve inquiries related to charge capture and complex regulatory billing matters, including Provider-Based status rules, OPPS, CCI, and MUE.

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

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

• Mentor and support members of the Revenue Integrity Team as an informal leader.

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

• Stay updated on professional and technical knowledge through workshops, publications, networks, industry best practices, and professional societies.

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

• Safeguard confidential financial and patient information.

• Support the finance operations of Northwestern Medicine.

⛳️ Requirements

• Bachelor’s Degree in Business or a related field or 10 years of relevant experience with progressive advancement.

• Proficient in Microsoft Office Suite.

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

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

• Extensive familiarity with Medicare/Medicaid regulations.

• Strong skills in communication, collaboration, and analysis.

• Ability to think critically, exercise decisive judgment, pay high attention to detail, and 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.

• Beginner to moderate knowledge of SQL and relational databases is preferred.

• RHIA or a related healthcare credential is preferred.

• Successful completion of the required background check and authorization/disclosure form.

🏝️ Benefits

• Tuition reimbursement.

• Loan forgiveness.

• 401(k) matching.

• Lifecycle benefits.

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

• Protection against unexpected life events.