Supv Commercial Reimbursement

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

JOB INFORMATION

Effective Date:

2/1/2017

Entity:

Wisconsin

Job Code:

302004

Job Title:

Supv Commercial Reimbursement

FLSA Exemption Status:

Exempt

Management Level:

Supervisor/Program Manager

JOB SUMMARY

Under the general direction of the Manager, Charge Capture and Commercial Billing and Reimbursement and the Director,  Revenue Cycle the Supervisor of Commercial Billing and Reimbursement is responsible for planning, directing, coordinating operation and activities of the commercial payors billing and insurance followup for UW Health's and related entities' hospital and professional services. 

This position is responsible for the financial control, supervision and support of the billing and collection for hospital and professional services, management of commercial payer accounts receivable, and maximization of commercial payer reimbursement.  The supervisor ensures timely and accurate payment and suggests edits to ensure proper billing.  This position is responsible for the conduct, operations, and results of the supervisory staff to ensure that operations maximize reimbursement and are in compliance with payor requirements.  This individual implements procedures to optimize efficiency and minimize the need for manual processing of charges and accounts. The success or failure of this has a direct impact on the financial balance of UW Health.

The Supervisor of Commercial Billing and Reimbursement assists the manager in developing departmental policies, programs, and procedures; and evaluates and implements departmental systems and procedures to maximize efficiency.  This position also assesses personnel and fiscal implications of organizational changes of these programs and assists staff in implementation of changes. 

Supervisory duties also include recruitment and training of staff, establishing and monitoring performance benchmarks, conducting performance evaluations, maintaining time records for payroll, and ensuring positive relationships with payers, patients, as well as internal/external customers and clients. 

ESSENTIAL DUTIES

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Responsible for revenue cycle performance of University of Wisconsin Hospital and Clinics, University of Wisconsin Medical Foundation, University of Wisconsin Systems, Generations Fertility Care, Madison Surgery Center, Transformations Surgery Center, Wisconsin Dialysis, Wisconsin Sleep, and Access Community Health Centers.

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Maximize commercial payer reimbursement in compliance with payer requirements.

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Recommends procedures with for addressing specific issues toward improved payments, payer requirements and eliminating the obstacles to timely claim adjudication.

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Keeps current on reimbursement and billing issues as well as implementing the changes in the billing current practices. Acquires and maintains thorough knowledge of federal and state legislative and administrative action affecting reimbursement; disseminates acquired knowledge to faculty.

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Maintain relationships with payor representatives to help resolve claims and ensure timely reimbursement

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Implements new policies and procedures as needed to maximize reimbursement for all services rendered in compliance with established commercial payer guidelines.

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Participate, coordinate, and monitor EPIC system changes to ensure accuracy.

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Effective leadership skills. Knowledge of supervisory skills and responsibilities.

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Ability to implement change in a positive, sensitive and forward-thinking manner

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Develop goals and objectives and establish priorities for staff

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Ability to effect collaborative alliances and promote teamwork

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Ability to user various computer applications including Microsoft Office Suite and EPIC

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Serve as Administrator for payor web portals

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Knowledge of general accounting principles

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Knowledge of medical terminology

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Knowledge and understanding of state and federal health rules and regulations

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Knowledge of EDI claims and remittance advice processing preferred

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Supervise day-to-day operations of personnel in the UW Health Business Office

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Interview and hire qualified job applicants

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Orient new employees on overall job requirements, policies and work procedures.

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Establish clearly defined assignments as determined by administrative goals and directives and personal judgment.

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Formulate new processes and procedures in order to improve the efficiency of the unit. New processes and

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procedures may affect all fiscal personnel.

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Develop training programs for Business Office personnel regarding: collection techniques and third party payor

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payment requirements, operating needs, computer system issues and laws and regulations relating to the

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performance of the unit/department.

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Coordinate with other Revenue Cycle staff to develop edits to reduce denials.

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Assist staff in resolving complex payor issues and/or identifying root causes of denials.

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Monitor claim edits to ensure claims are processing in a timely manner.

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Provide prompt and accurate response to staff questions, problems or informational needs.

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Prepare formal performance evaluations and counsel employees on performance and/or work behavior.

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Maintain time records, approve time off and monitor attendance to assure proper staff coverage.

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Plan, organize and coordinate the activities of the unit.

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Meet A/R goals set by the department management and administration including CEO, CFO and the Vice President, Revenue Cycle

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Complete and timely resolution of patient accounts.

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Staff are trained and monitored for compliance with internal policies and procedures

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Annual performance reviews

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

Associate's Degree

from an accredited college or university in business, healthcare administration or related major

Required

Relevant experience or significant progress towards Bachelor’s degree may be considered in lieu of degree

Bachelor's Degree

from an accredited college or university in a business, healthcare administration or related major

Preferred

3 years

of experience in a healthcare revenue cycle or at least 1 year of related experience in a leadership role

Required

3 years

management experience in healthcare revenue cycle operations for a large, complex health care environment, including experience in an academic medical center

Preferred

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

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Ability to make good judgments in demanding situations

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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 organize details

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Responsible for medium to large scale projects involving multiple resources and spanning many months from start to finish

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Ability to manage multiple concurrent activities

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Effective organizational, planning, scheduling and project management abilities

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Effective communication skills both in written and verbal presentation with a communication style that is open and fosters trust, credibility and understanding.

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Ability to analyze data and workflows in order to develop and analyze options, recommend solutions, and solve complex problems and issues

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Strong customer service and human relations abilities

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Ability to effect collaborative alliances and promote teamwork

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

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Ability to use various computer applications is preferred including EPIC

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

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Broad knowledge of health care and/or hospital business office practices and principles

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Knowledge of general accounting principles

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Knowledge of medical terminology

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Knowledge and understanding of state and federal rules and regulations including laws regarding confidentiality, compliance, release of information, probate and lien legislation, Fair Debt Collection practices, and insurance regulations.

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Knowledge of Provider Enrollment and Credentialing

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Effective leadership skills. Knowledge of supervisory skills and responsibilities

• Ability to implement change in a positive, sensitive and forward-thinking manner
• Planning and problem solving
• Developing goals and objectives, and establishing priorities
• Inspires confidence, Good judgment and ability to act decisively at the right time
• Self-starter with a willingness to try new ideas
• Positive, can-do attitude coupled with a sense of urgency
• Ability to persuade others and develop consensus

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

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Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be negligible amount, a job is in this category when it requires walking or standing to a significant degree.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

☐

Medium: Ability to lift up to 50 pounds maximum with frequent lifting and/or carrying objects weighing up to 25 pounds.

20-50#

10-25#

Negligible-10#

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Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds.

50-100#

25-50#

10-20#

☐

Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

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.

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.