Reimbursement Lead

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

JOB INFORMATION

Effective Date:

8/12/2026

Entity:

Wisconsin

Job Code:

440058

Job Title:

Reimbursement Lead

FLSA Exemption Status:

Non-Exempt

Management Level:

Individual Contributor

JOB SUMMARY

Under the general supervision of the Revenue Cycle Supervisor, the Reimbursement Lead is responsible for monitoring a large portfolio of account receivables and is engaged in pro-active collection of outstanding balances.

The employee performs complex patient account follow-up activities; actively participates in quality improvement initiatives, and assists with special projects, as needed.  The individual is also responsible for answering questions regarding team functions, assisting management with team direction, and monitoring the accuracy and timely processing of appeals to various payers or programs.  

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 positon requires a thorough understanding of complex contracts, third party payer requirements, government regulations, and in-house computer applications for billing and accounts receivable.

The individual also serves as a technical expert for the reimbursement, responsibilities include: training new staff, providing ongoing training to existing staff, as well as being able to perform all of the duties of the Reimbursement Representative.  The incumbent monitors activities performed by Reimbursement Representative staff to ensure accounts are reconciled appropriately and provides direction as necessary.  A significant degree of independent judgment and decision making is required.

This position represents UW Health and the Revenue Cycle team by adhering and upholding the UW Health Mission, Vision, and Values, and UW Health Service Performance Standards in providing the highest quality service. They will support their co-workers, engage in positive interactions, and provide helpful assistance in anticipating and responding to the needs of our customers.

ESSENTIAL DUTIES

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Lead Responsibilities:
Provide general assistance to the Reimbursement Team.
o Train new staff and provide ongoing training for existing staff
o Monitor activities performed by reimbursement staff to make sure that accounts are reconciled appropriately and timely
o Complete quality improvement and productivity activities
o Answer questions regarding team functions and assist with team direction
o Review adjustments made by staff members according to internal audit policy

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

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Analyze and reconcile denied payment transactions.

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Compile and file all information needed to appeal denials

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Follow federal and state regulations to ensure compliance standards are met

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Monitor timely filing requirements on claims and appeals

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

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

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Verify patient coverage information and update registration as required

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Accurately document all actions taken to reconcile outstanding balances

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

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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.

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

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

•

Complete work on special projects, queries and reports as assigned

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Support co-workers and engage in positive interactions.

•

Communicate professionally and timely with internal and external customers

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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.

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

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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

No minimum education required.

High School Diploma

or equivalent

Preferred

Associate's Degree

in Business, Finance, Health Information Management or related field

Preferred

2 years

of experience in a healthcare revenue cycle or clinic operations role

Required

or

1 year

experience in a healthcare revenue cycle operations role plus 1 year of prior leadership (Team Lead or above) experience.

Required

• Epic experience

• Three years of experience in a healthcare revenue cycle or clinic operations role with progressive leadership responsibilities.

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

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 and accurately organize details

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Ability to manage multiple tasks with ease and efficiency

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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

•

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

•

Maintain confidentiality of sensitive information

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Knowledge of Business Office policies and procedures

•

Knowledge of local, state and federal healthcare regulations

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

☒

Sedentary: Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, 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 occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If someone can do light work, we determine that they can also do sedentary work, unless there are additional limiting factors such as loss of fine dexterity or inability to sit for long periods of time.

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: Medium work involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. If someone can do medium work, we determine that they can also do sedentary and light work.

20-50#

10-25#

Negligible-10#

☐

Heavy: Heavy work involves lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds. If someone can do heavy work, we determine that they can also do medium, light, and sedentary work.

50-100#

25-50#

10-20#

☐

Very Heavy: Very heavy work involves lifting objects weighing more than 100 pounds at a time with frequent lifting or carrying of objects weighing 50 pounds or more. If someone can do very heavy work, we determine that they can also do heavy, medium, light, and sedentary work.

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.