NI-Reimbursement Representative

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

1/12/2025

Entity:

Illinois

Job Code:

NI-4477AC

Job Title:

NI-Reimbursement Representative

FLSA Exemption Status:

Non-Exempt

JOB SUMMARY

The Reimbursement Representative is responsible for a portfolio of accounts receivable and is engaged in pro-active collection of outstanding balances, including accurate and timely processing of appeals, with government or third-party payors.

Prompt resolution of outstanding balances involves working with UW Health internal and external customers (e.g., third party payers, patients and their guarantors, estate representatives, attorneys, clinicians, employers, and UW Health employees).  Additionally, this position requires a thorough understanding of often complex contracts, third party payer requirements, government regulations, and in-house computer applications for billing and account receivables.

ESSENTIAL DUTIES

•

Follow up with third party payers and patients on outstanding account balances (including credit balances) to facilitate prompt resolution of outstanding account balances.

•

Analyze and reconcile denied payment transactions.

•

Compile and file all information needed to appeal denials.

•

Following federal and state regulations to ensure compliance standards are met.

•

Monitor timely filing requirements on claims and appeals.

•

Follow-up with contracted payers to secure payments on outstanding balances.

•

Evaluate third party payments to ensure accuracy relative to contract language (underpayment/overpayment).

•

Verify patient coverage information and update registration as required.

•

Accurately document all actions taken to reconcile outstanding balances.

•

Communicate with Revenue Cycle teams, payers and others to resolve account problems.

•

Evaluate the payment status of outstanding third party claims and resolve any impediments to payment by providing information such as appropriate medical records, detailed itemization of charges, information regarding other insurance benefits, and explanation of charges.

•

Review and validate adjustments to accounts in the insurance portfolio based on insurance reimbursement and coverage, contracts, services provided.

•

Review charges to ensure we are filling to correct guarantor (e.g. work comp vs. personal/family).

•

Complete work on special projects, queries and reports as assigned.

•

Support co-workers and engage in positive interactions.

•

Communicate professionally and timely with internal and external customers.

•

Demonstrate friendliness by smiling and making eye contact when greeting all customers.

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Provide helpful assistance in anticipating and responding to the needs of our customers.

•

Collaborate with customers in planning and decision making to result in optimal solutions.

•

Ability to stay calm under pressure and deal effectively with difficult people.

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Non-Clinical

JOB REQUIREMENTS

High School Diploma

or equivalent.

Required

Associate's Degree

in Business, Finance, Health Information Management, or related field.

Preferred

1 year

of experience in an insurance, finance, medical, hospital, or customer service-related field.

Required

Revenue Cycle (healthcare business, financial or insurance) experience.

Preferred

Epic experience.

Preferred

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

•

Knowledge of medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, 1500) preferred.

•

Ability to make good judgments in demanding situations.

•

Ability to react to frequent changes in duties and volume of work.

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Effective communication skills.

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Ability to listen empathetically.

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Ability to logically and accurately organize details.

•

Ability to manage multiple tasks with ease and efficiency.

•

Self-starter with a willingness to try new ideas.

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Ability to work independently and be result oriented.

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Positive, can-do attitude coupled with a sense of urgency.

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Effective interpersonal skills, including the ability to promote teamwork.

•

Strong problem solving skills.

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Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders.

•

Ability to use various computer applications including EPIC.

•

Excellent PC operating skills (keyboard, mouse) and use of MS Office.

•

Broad knowledge of health care business office practices and principles.

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Basic math skills and knowledge of general accounting principles.

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Maintain confidentiality of sensitive information.

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Knowledge of Business Office policies and procedures.

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Knowledge of local, state and federal healthcare regulations.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Standing

X

Walking

X

Climbing

X

Bending

X

Crouching

X

Pushing / Pulling

X

Carry

X

Fine Hand / Eye Coordination

X

Color Discrimination

X

Hearing Ability

X

Lifting / Lowering 1 -15 lbs.

X

15 - 30 lbs.

X

30 - 50 lbs.

X

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Concentration on Detail

X

Attention Span of 1 + Hours on a Task

X

Ability to Remember Multiple Tasks

X

Oral Communication

X

Written Communication

X

Exposure to Blood and Body Fluids

X

Exposure to Toxins, Cytotoxins, Poisons

X

Exposure to Extreme Heat, Cold, Temp Fluctuations

X

Exposure to Hazardous Chemicals

X

Exposure to Radiation

X

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.