Sr Reimbursement Manager

Medical College of Wisconsin

parental leave, paid holidays, tuition reimbursement, 403(b)

United States, Wisconsin, Milwaukee

Jan 06, 2025

Position Description:

We're looking for those individuals-the creative thinkers and innovation seekers-who are content with nothing short of changing the world. Discover the endless opportunities within the Medical College of Wisconsin (MCW) and be inspired by the work we can do together to improve health, and make a positive, daily impact in our communities. In the role of a Senior Reimbursement Manager you will be working in the Surgery Department.

Purpose

The Sr. Reimbursement Manager collaborates with Department Administration, Providers, Clinical Practice Services (CPS) Billing and Collection staff, and related Children's and Froedtert clinics and ancillary areas to improve processes and maximize collections for the assigned Clinical Department Specialties, within regulatory constraints. Manages claims' matters related to front-end and back-end revenue cycle processes such as patient registration, managed care referrals/ prior authorizations, charge capture, medical record documentation, coding and billing, claims adjudication and accounts receivable (AR) follow-up for payment and denial resolution. Utilizes coding principles and specific coding knowledge to identify opportunities to improve reimbursement. Analyzes AR and monthly financial reports to track key indicators to keep clinical department faculty and CPS informed of financial statistics. Safeguards or strengthens existing relationships. Manages staff, resources and operations to maximize professional billings and reimbursement in the most compliant manner for the Department of Surgery. Performs financial and business-related analysis, data manipulation and interpretations to be shared with leaders. Supports the departments operations and consistently seek out opportunities for process improvement and workflow efficiency. This position serves as a key contact for the Department Management and Physicians and has a dual reporting relationship with the Clinical Department and CPS.

Primary Functions

Manage reimbursement processes for the Department to ensure proper coding, billing and reimbursement procedures are followed to ensure maximized reimbursement.
Recruit and supervise staff, establish performance guidelines/standards, conduct evaluations, develop training strategies for new and current staff. Recommend salary increases, reclassifications, promotions and budgetary recommendations. Initiate and carry out corrective actions as necessary following department, college and legal guidelines.
Develop communication among all Department divisions to support all areas of the Epic system to enhance and support the coding and documentation with all providers including coding; level of services selection; Medicare/Medicaid regulations within the system; documentation; clinical procedure documentation and order entry of all charge related services to capture all services that are provided. Provide feedback to all providers of activities that are not meeting coding standards.
Oversee the revenue cycle process to include but not limited to registration, referrals/ authorizations, documentation, charge capture, records management, correct ICD-10-CM and CPT coding, modifier application, and claims processing.
Monitor and perform follow-up on medical billing through review, investigation and communication with others to include reports such as:

Surgical file, if applicable
Monthly global reports
Monthly Pre-authorization write-off reports
60-day report
Ad hoc reports
Physician profile reports
Rejection reports

Compliance reports
Timely filing write-off report
Appeal follow-up form
Fee and wRVU reporting for estimates and analysis
CPT cube access
Review of monthly Data warehouse reports

Resolve complex issues and concerns in collaboration with administration, providers, coders, business office staff, and hospital staff (i.e. FH, CMH, CHW, and other off-site locations) with-in the revenue cycle process to include but not limited to registration, referrals/ authorizations, documentation, charge capture, records management, correct ICD-10-CM and CPT coding, modifier application, and claims processing to ensure proper reimbursement.
Evaluate efficiency of billing and collections to aid in managing accounts receivables and identify trends that will impact financial results. Make recommendations to improve billing processes. Perform audits, provide feedback to billing staff and providers on correct CPT and ICD-9 coding guidelines, modifier application, and government or payer regulations.
Conduct and participate in meetings with stakeholders. Establish, improve, and maintain appropriate internal and external communication. Facilitate professional affiliations and participate in professional development including certification programs.
Provide suggestions for improvement and develop action plan. Prepare supporting documentation that illustrates the impact on the revenue cycle or improvement to an existing process within CPS or the Clinical Department(s).
Manage certain patient-facing functions, such as the coordination of package-priced or other cash-pay services, working with other departments and hospitals to ensure appropriate charge and payment posting.
Identify the need for and participate in the development of departmental policies and/or processes involving complex or potentially sensitive issues, as requested.
Research and communicate new CPT codes or new services performed, accurate reporting, expected reimbursement and documentation requirements using authoritative sources. Collaborate with CPS Charge Capture Management and EPIC teams on charge capture set up.
Act as a resource to the CPS coding specialists and provide education, training as necessary to minimize denials and defend the maximum reimbursement.
Participate in new provider orientations including medical record documentation and education.
Works with CPS leader to co-manage reimbursement manager including providing on-going feedback to Reimbursement Manager and annual performance evaluation.
Support complex department missions/lines of business with training and guidance of department billings and reimbursement
Review and provide input on government and compliance audits within the Department of Surgery.
Participate in short and long-range projects at the direction of leadership. Suggest and participate in process improvements and changes.
Perform other duties as assigned.

Knowledge - Skills - Abilities

Solid understanding of medical operations, and the revenue cycle as it specifically relates to surgery.
Extensive knowledge of payer contracts, government regulations and third-party policies as they impact operational efficiency, medical coding, reimbursement, contracting and payment processing.
Knowledge of human resource management practices including supervision, training/mentoring, hiring and disciplinary procedures.
Excellent communication skills. Collaborative and team-oriented style.
Ability to take initiative and to exercise independent judgment, decision making and problem-solving skills.
Proactively anticipates and is flexible to changes in the business environment.
Constantly looking for ways to support performance improvement initiatives.
Able to adapt quickly to changes in work conditions or priorities with revised or reorganized plans.
Ability to listen critically to solicit ideas from operational participants at all levels.
Ability to identify how systems and applications supporting the business processes work.
Strong technical analytical skills. Mastery of Microsoft Excel, Word and Outlook.
Willingness to support development and deliver training to department stakeholders.
Ability to maintain confidential information and demonstrate integrity in all interactions.
Avid attention to detail with the ability to understand and integrate detail with the big-picture.
Knowledge of quality control, customer service standards, information management, procedural process, and recordkeeping.
Experience extracting and abstracting data utilizing an electronic medical record. Experience navigating in a professional fee billing system environment, preferred. Working knowledge of Excel, preferred. Knowledge of quality assurance, information management, procedural process, and recordkeeping. Computer, technical, interpersonal, oral communication, listening, and patience skills.

#LI-AV1

Preferred Schedule:

Monday through Friday 8:00-5:00 and hours as needed

Position Requirements:

Specifications

Appropriate experience may be substituted for education on an equivalent basis

Minimum Required Education: Bachelor's degree

Minimum Required Experience: Seven years

Preferred Education: Healthcare Business Administration

Preferred Experience: Healthcare Business Administration, and Professional fee coding experience related to the Clinical Department assignment (for example Surgical Coding if in Surgical Department, or Medicine specialty coding if assigned to Medicine Department)

Field: Business administration or healthcare administration; professional fee coding experience

Certification: Coding certification

Why MCW?

Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options
403B Retirement Package
Competitive Vacation and Paid Holidays offered
Tuition Reimbursement
Paid Parental Leave
Pet Insurance
On campus Fitness Facility, offering onsite classes.
Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.

For a full list of positions see: www.mcw.edu/careers

For a brief overview of our benefits see: https://www.mcw.edu/departments/human-resources/benefits

Eastern Wisconsin is a vibrant, diverse metropolitan area. MCW is intent on attracting, developing, and retaining a diverse workforce and faculty body that reflects the community we serve. We value diversity of backgrounds, experience, thought, and perspectives to advance excellence in science and medicine. MCW is a welcoming campus community with a strong culture of collaboration, partnership, and engagement with our surrounding community. For more information, please visit our institutional website at https://www.mcw.edu/departments/office-of-diversity-and-inclusion.

MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination

The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering a diverse community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.