At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

The Manager, Revenue Integrity reflects the mission, vision, and values of Northwestern Medicine (NM), 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 Manager, Revenue Integrity will accomplish department objectives by managing a multi-skilled team and developing positive working relationships with both colleagues and consultancies to support the financial and operational objectives of NM. The Revenue Integrity CDM/EAP & Pricing Manager will be tasked with planning and overseeing completion of a full range of department activities. The Revenue Integrity CDM/EAP & Pricing Manager will need to understand complex financial requirements/concepts in a fast paced environment.

The Manager, Revenue Integrity is responsible for interacting with maintaining the CDM/EAP chargeables to ensure that all billable items and services such as procedures, patient visits, supplies, and pharmaceutical that are charged through the CDM/EAP are described, coded, and priced appropriately and are representative of service provided. The CDM/EAP & Pricing Manager is also responsible for evaluating regulatory guidelines of billable services to ensure compliance.

The Manager, Revenue Integrity maintains rational and defensible charges for hospital services. Factors which impact upon hospital price-setting include market conditions, costs of patient care, governmental payment rates, local demographic factors, clinical labor workforce shortages, new technology costs, local standards for patient care, local economic conditions and hospital financial condition, among others. The CDM/EAP & Pricing Manager recommends rate-setting methodologies within the hospital billing system and any integrated systems, including clinical systems such as pharmacy, laboratory, supplies, and any other ancillary systems.

Responsibilities:

• Meet departmental objectives by overseeing completion of the full range of department assignments 
• Establish department goals, forecast requirements, prepare / support management in preparation of department annual budget, schedule expenditures, analyze variances, and initiate appropriate corrective actions
• Carry out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems
• Review, edit, and enhance work prepared by members of the finance team
• Prepare special reports by collecting, analyzing, and summarizing information and trends as needed
• Deliver and communicate monthly results of operations to senior leadership, finance leadership and operational leadership as needed
• Maintain quality service standards as well as analyzing and resolving quality and customer service problems, identifying trends, and recommending and implementing system improvements
• Research and understand changes in the regulatory environment in order to determine appropriate treatment as needed
• Demonstrates knowledge in computer applications such as knowledge in databases, spreadsheets and word processing applications in a high complexity environment
• 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
• Support the Northwestern Medicine finance operation as an integrated team leader
• Set annual goals for CDM/EAP and Pricing key performance indicators to include and report departmental performance around goals and national benchmarks to the Director of Revenue Integrity
• Facilitate positive communication and build strong relationships between Revenue Integrity, clinical operations, finance, and hospital administrator regarding CDM/EAP and pricing matters
• Maintains staff performance results by training, counseling, developing personal growth opportunities, and disciplining employees; planning, monitoring, and appraising job results. This includes the enforcement of systems and policies as well as productivity standards
• Oversees the governance with the pricing structure of each hospital and CASC (ambulatory surgical center) fee schedules in Epic
• Manages the Revenue Integrity team in performing periodic audits on accuracy/completeness of CDM/EAP data elements
• Requires maintaining technical knowledge to support organization with questions related to charge capture and complex regulatory billing issues (e.g. OPPS, CCI, MUE)

Required:

• Bachelor's degree in business, finance, or healthcare related field
• Minimum of five (5) years related management experience and leading multi-disciplinary teams in operational finance, CDM, charge capture, or related environment
• Requires high attention to detail, strong communication, collaboration, and analytical skills
• Advanced understanding of CPT, HCPCS, ICD-10, and third party billing requirements
• Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance
• Effective communication skills
• Experience in a fast paced, dynamic environment
• Epic Certification in Resolute Hospital Billing and/or CDM
• Ability to summarize complex issues into key elements
• Leadership and flexibility managing relationships in large corporate environment
• Advanced knowledge of Microsoft Excel

Preferred:

• Epic Certification in Clarity Reporting
• Coding certification (e.g., RHIA, RHIT, CPC, CPC-H, or CCS)
• Intermediate knowledge of SQL and relational database

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.