Senior Compliance Associate - Hospital Billing

Northwestern Memorial Healthcare • Chicago, IL

11d

About The Position

The Senior Compliance Associate – Hospital Billing supports the mission, vision, and values of Northwestern Medicine and follows its Code of Ethics, Corporate Compliance Program, and applicable policies, procedures, regulatory requirements, and accreditation standards. The role assists department managers and directors with implementing the NMHC Corporate Compliance Program and may lead key initiatives.

The position responds to hospital billing compliance concerns, supports and conducts investigations and compliance reviews, coordinates regulatory inquiries and audits, and monitors compliance risks and regulatory changes. It also contributes to the annual Compliance Work Plan, compliance policies and procedures, committee activities, and the development of organizational compliance metrics.

Requirements

• Bachelor’s degree or 6 to 8 years of compliance, clinical, or legal experience.
• Certified coder (e.g., RHIA, RHIT, CCS, CCS-P, or equivalent) or eligible for certification.
• Healthcare experience related to hospital inpatient services, which may include compliance, regulatory, legal, coding, billing, auditing, or clinical operations.
• Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint, and Access, and related business software.
• Strong written, verbal, and interpersonal skills, with the ability to communicate and collaborate effectively with stakeholders at all organizational levels.
• Ability to handle confidential and sensitive information with discretion and professionalism.
• Ability to convey complex information clearly, concisely, and professionally.
• Strong organizational, analytical, and problem-solving skills, with the ability to manage multiple priorities in a fast-paced environment.

Nice To Haves

• Registered Nurse (RN) with clinical auditing, compliance, utilization review, or nurse auditor experience to perform medical necessity reviews.
• Juris Doctor (JD), or related experience interpreting and applying state and federal healthcare regulations.
• Certified in Healthcare Compliance (CHC).
• Knowledge of both hospital and professional billing.
• Proficiency in Epic and MDAudit.

Responsibilities

• Respond to hospital billing compliance inquiries and concerns, including reports received through the Compliance Hotline; assess issues, provide guidance, triage matters to stakeholders, and document reports and resolutions.
• Conduct and support hospital billing compliance investigations by gathering and analyzing information, interviewing stakeholders as appropriate, identifying root causes, documenting findings, and recommending corrective action and process improvements.
• Lead compliance reviews and follow-ups related to hospital billing and inpatient services, including reviews of billing accuracy, coding compliance, documentation sufficiency, medical necessity, and compliance with state and federal requirements.
• Coordinate regulatory inquiries, audits, and investigations involving CMS, OIG, and other federal and state agencies; assist with medical record and claim reviews, clinical documentation quality assurance, and response preparation.
• Identify, assess, and monitor healthcare compliance risks across the health system; recognize emerging issues, recommend mitigation strategies, and elevate concerns to leadership.
• Monitor regulatory trends and changes affecting the health system and its subsidiaries, assess their organizational impact, and maintain current knowledge of applicable compliance and regulatory guidelines.
• Assist with developing and implementing the department’s annual Compliance Work Plan.
• Help develop and maintain compliance policies and procedures and provide policy-related guidance to individuals and departments.
• Coordinate and facilitate agendas and materials for compliance-related committees.
• Help develop department and organizational metrics to monitor compliance with rules, regulations, policies, and procedures.
• Perform other duties assigned by the department Manager, Director, or VP, Integrity.

Benefits

• Tuition reimbursement
• Loan forgiveness
• 401(k) matching
• A wide range of benefits supporting physical, emotional, and financial well-being and protection for unexpected life events

What This Job Offers

• Job Type: Full-time
• Career Level: Senior