Reimbursement Rep

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

JOB INFORMATION

Effective Date:

4/1/2023

Entity:

Wisconsin

Job Code:

440059

Job Title:

Reimbursement Rep

Exemption Status:

Non-Exempt

Management Level:

Individual Contributor

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.

MAJOR RESPONSIBILITIES

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Core Responsibilities:

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

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o Analyze and reconcile denied payment transactions.

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o Compile and file all information needed to appeal denials

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

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o Monitor timely filing requirements on claims and appeals

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

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o 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 and coverage, contracts, services provided.

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

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Complete work on special projects, queries and reports as assigned

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Customer Service Standards:

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Support co-workers and engage in positive interactions.

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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

ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS.

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.

• Epic experience

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

Preferred

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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

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Effective interpersonal skills, including the ability to promote teamwork

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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

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Ability to use various computer applications 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 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

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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

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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

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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#

☐

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#

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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:

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.