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Job Description
The Revenue Integrity Analyst reflects the mission, vision, and values of Northwestern Medicine, 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.
The Revenue Integrity Analyst will be responsible for duties classified under one of five subgroups of Revenue Integrity; CDM/Pricing, Charge Capture, Data Analytics, Professional Billing, and Project Management as detailed in the addendum section. The Revenue Integrity Analyst will support Finance, Clinical Departments and Revenue Cycle to ensure accurate, fair and compliant billing for services.
Responsibilities:
- Work and review the Revenue Integrity Account, Charge Review, Claim Edit, Router Review work queues for issue resolution; review for trends/recurring issues and identify required remediation efforts.
- Review departmental front-end charge capture tools for accuracy. Take necessary action to ensure accurate charging on patient accounts.
- Meet financial objectives by identifying and evaluating trends; analyzing variances; initiating any corrective actions or adjustments.
- Provide support and analysis by querying appropriate data, preparing reports, making presentations of analysis, findings, and recommendations to management.
- Research and understand changes in the healthcare regulatory environment and the potential impact on reporting.
- Lead efforts to assess, modify, and/or develop and implement more timely and consistent processes/systems to increase efficiency, accuracy, and meaningfulness of information.
- Complete special projects as directed by Revenue Integrity leadership
- Act as a liaison for Clinical Operations, Finance, IT, and Revenue Cycle to identify and resolve charge issues and special projects
- Effectively and professionally communicate results, challenges, and solutions through regular reports and monthly meetings with regional CFOs.
- Stay abreast of regulatory changes on a national and local level.
- 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.
- Research billing and coding regulations. Communicate and assist in implementing any necessary changes to impacted area that affect policy, financial, charge capture, patient care, billing, and coding operations.
- 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.
- Protect operations by keeping financial and patient information confidential.
Qualifications
Required:
- Bachelor’s Degree in Business, Healthcare Management, HIM, Finance or related field or 10+ years of equivalent experience with progressive advancement.
- 3+ years of relevant experience
- Excellent verbal and written communication, collaboration, analytical, and accounting skills
- Expert knowledge of Microsoft Office Suite
- Proven facilitation / presentation skills
- Moderate / Advanced understanding of CPT coding and third party billing requirements
- Knowledge and experience with Medicare/Medicaid regulation
- Minimum of one EPIC Certification or Certification must be obtained within six months of employment
Preferred:
- EPIC Certification (CDM, HB, PB, Clarity, and/or Caboodle)
- RHIA preferred or related health care credential (e.g. Radiology technician, RN, CPC, CPC-H, CCS, COC) or CPA or CHFP certification.
- Clinical experience blended with Finance/Revenue Cycle experience is a plus
- Experience in Healthcare Management, Business, MIS, Data Analytics, or related field.
- Beginner to Moderate knowledge of SQL and relational databases.
Additional Information
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.
Vacancy expired!