Sr. Analyst, Revenue Integrity, Procedural Supply Governance

Northwestern Memorial Healthcare • Warrenville, IL

13d

About The Position

The Sr. Analyst, Revenue Integrity, Procedural Supply Governance supports Northwestern Medicine’s Clinical Departments and revenue cycle through charge capture analysis, including annual price increase analysis, and helps maintain the charge master to ensure compliance, accuracy, and consistency. The role prepares analysis and support for management and Clinical Departments and complies with the organization’s policies, ethics requirements, and applicable regulatory and accreditation standards.

The Senior Revenue Integrity Analyst works with Revenue Cycle, IT, and clinical departments to connect EPIC and the charge master; researches billing and coding rules; and supports financial, operational, and revenue cycle projects. The role also mentors team members informally and helps improve processes and systems for more timely, consistent, and useful information. This position requires protecting confidential financial and patient information.

Requirements

• Bachelor’s degree in Business or a related field, or 10 years of equivalent experience with progressive advancement.
• Proficiency with the Microsoft Office suite.
• At least 5 years of experience in a revenue cycle or revenue integrity role.
• Advanced understanding of CPT, HCPCS, ICD-10, and third-party billing requirements.
• Extensive knowledge of and experience with Medicare and Medicaid regulations.
• Strong communication, collaboration, and analytical skills.
• Critical thinking, decisive judgment, high attention to detail, and ability to work with minimal supervision.
• Knowledge of databases, spreadsheets, and word-processing applications in a high-complexity environment.

Nice To Haves

• EPIC Certification (Resolute Charge Capture).
• EPIC Certification (Clarity Report Data).
• Master’s degree in Healthcare Management, Business, MIS, Data Analytics, or a related field.
• Beginner to moderate knowledge of SQL and relational databases.
• RHIA or a related health care credential, such as radiology technician or RN.

Responsibilities

• Perform daily maintenance and quarterly audits of the EAP.
• Prepare files required for department builds in the EAP database.
• Identify charge capture opportunities in revenue-producing departments.
• Research and interpret billing and coding regulations, communicate relevant changes, and apply changes affecting policy, finance, charge capture, patient care, billing, and coding operations.
• Lead quarterly audits of charge master data elements.
• Review departmental front-end charge capture tools for accuracy.
• Lead complex audits and prepare methodology for annual pricing and/or coding changes.
• Troubleshoot complex account errors and provide Revenue Manager(s) with education on resolution.
• Resolve questions concerning charge capture and complex regulatory billing issues, including Provider-Based status rules, OPPS, CCI, and MUE.
• Liaise with Revenue Cycle, IT, and clinical departments to connect EPIC and the charge master.
• Research, compile, and analyze financial data and organize and maintain database files for financial modeling.
• Mentor and support Revenue Integrity Team members as an informal leader.
• Assess, modify, develop, and implement processes and systems to improve timeliness, consistency, efficiency, accuracy, and usefulness of information.
• Maintain professional and technical knowledge through education, publications, networking, industry best practices, and professional societies.
• Support finance, operations, and revenue cycle teams through special projects.
• Protect confidential financial and patient information.
• Support Northwestern Medicine’s finance operation.

Benefits

• Competitive benefits, including tuition reimbursement, loan forgiveness, and 401(k) matching.
• A wide range of benefits intended to support physical, emotional, and financial well-being and provide protection for unexpected life events.

What This Job Offers

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