Jan 16, 2024

Reimbursement Manager

  • Medical College of Wisconsin
  • Hybrid (8701 Watertown Plank Rd, Wauwatosa, WI, USA)
Full Time (CEDC) Certified Emergency Department Coder

Job Description

Every great life-changing discovery begins the same way—with new knowledge. It can change everything, from a single life to the future of entire communities. That’s why academic medicine, and the continuous pursuit of knowledge, is at the center of everything we do at the Medical College of Wisconsin (MCW).

Purpose

The role of Reimbursement Manager, in the Department of Emergency Medicine,  you will serve as a physician and staff resource to maximize professional billings and reimbursements. Partner with 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 department of Emergency Medicine, within regulatory guidelines. Acts as liaison and integrates systems related to patient registration, managed care referrals/authorizations, charge capture, medical records, coding/billing, insurance companies, denials process, reimbursement team activities and collection department activities in order to maximize charge capture and collections. Performs physician and staff training with respect to billing and collection.

 

Primary Functions

  • Work closely with Clinical Practice Services (CPS) team. Monitors the appropriateness of coding, documentation and charge capture process. Assists with the resolution of problems with respect to coding and documentation.
  • Coordinate and monitor activities with respect to:  clinic charge capture reconciliation, offsite charge capture, pre-authorization activity, insurance updates, encounter forms etc. Reimbursement Manager acts as a resource for insurance and/or coding questions.
  • Act as liaison with affiliate hospitals’ registration, charge entry staff, reimbursement team, collections department, physicians and medical records to ensure maximum charge capture, billing and collections for services. Attends meetings, discusses issues as needed and assists with resolution of interdepartmental billing problems as needed. Assists in the development of improvement initiatives for any issues that are identified.
  • Monitor and follow-up on invoices through review, investigation and communication with the reimbursement team, billing specialists and other departments.
  • Prepare monthly reports as decided upon by the department, monthly write-off reports and ad hoc reports and physician logs. Conduct audits when necessary.
  • Monitor weekly charge/payment reports to ensure appropriate work and cash flow for the services.
  • Monitor trends and assist with the resolution of billing problems in order to decrease the number of write-offs and increase collections.
  • Provide on-going training/education for staff physicians, residents and clinical support staff regarding professional charges, coding, use of modifiers, documentation, processes and reimbursement.
  • Assist with billing related activities such as clinic form development, annual fee updates, patient billing questions and collection of co-pays/deductibles. Attends billing meetings as needed. Participates on billing committees as needed.
  • Complete special reimbursement projects as needed.

Knowledge – Skills – Abilities

Strong working knowledge of clinic operations, reimbursement practices, procedure coding/use of modifiers and monitoring of reimbursement trends. Ability to handle multiple tasks simultaneously. Working knowledge of insurance/managed care. Excellent written and verbal communication skills. Problem-solving skills. Professional and confident demeanor. Experience with Excel, Word and IDX. 

Knowledge of quality control, customer service standards, information management, procedural process, and recordkeeping.

Computer, technical, interpersonal, oral communication, listening, and patience skills.

 

Specifications

Appropriate experience may be substituted on equivalent basis

Minimum Required Education: Bachelor’s degree

Minimum Required Experience: 5 years

Preferred Certification:  Certified Emergency Department Coder (CEDC)                      

Field: Business administration or healthcare administration

 

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
  • 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.

Required Experience Level

Intermediate Level

Minimum Education

Bachelor's Degree

Minimum Experience Required

4-6 years

Required Travel

No required travel