JOB DESCRIPTION FOR JOB TITLE:



|SUPERVISOR, GOVERNMENT BILLING AND REIMBURSEMENT |

|Job Code: 302006 |FLSA Status: Exempt |Mgt. Approval: M. Flemming |Date: January 2020 |

|Department : Government Billing and Reimbursement |HR Approval: J. Theisen |Date: January 2020 |

|JOB SUMMARY |

|Under the direction of the Manager of Government Reimbursement and the Program Director of Revenue Cycle, the Supervisor of Government Reimbursement oversees government|

|billing and account representatives ensuring the accuracy of government claims filing and reimbursement. Extensive knowledge in Medicare and Medical Assistance programs|

|is crucial in the success in this position. These separate entities are governed by constantly changing Federal and State regulations. Failure to comply with these |

|regulations could result in substantial penalties to UW Health. |

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|The incumbent will oversee reimbursement representatives. This staff is responsible for timely and accurate follow-up and denial management to ensure all claims are |

|processed and paid correctly by the payer. Consistent annual performance reviews will be held by the incumbent for each staff member as well as intermittent staff |

|touch-base meetings as necessary. |

| |

|The position prepares and presents reports, assists the Manager and Program Director in establishing department policies and procedures, evaluates, initiates, and |

|implements various department systems and procedures and revises processes as necessary to maximize efficiency. The individual shall maintain a foundational |

|understanding of Epic functionality in order to facilitate said changes. The position assesses fiscal and personnel implications of program changes, assists staff in |

|implementing changes, and monitors and analyzes the impact of change. |

| |

|Review of program memorandums regarding updates with Medicare and Medical Assistance and related education to staff is a crucial part of the incumbent’s |

|responsibilities. This position requires effective communication and organizational skills, as well as knowledge of medical terminology, registration requirements for |

|health care billing, and third-party payer requirements for Medicare and Medical Assistance. The ability to problem solve, multi-task and follow through with |

|obligations are all necessities in the success of this role. The incumbent is responsible for complicated account follow-up and management of high-dollar account |

|issues. A strong knowledge of internal and external processing related to electronic billing is also necessary. The success or failure of this has a direct impact on |

|the financial balance of UW Health. |

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|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. |

|MAJOR RESPONSIBILITIES |

|Core Responsibilities: Incumbent performs job demonstrating technical ability, understanding of job expectations and compliance with organization policies and |

|procedures. |

|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. |

|Develop, implement and instruct staff in policies and procedures, payor billing and payment deadlines, and priorities toward reducing accounts receivable (A/R) and days|

|revenue outstanding (DRO), increasing cash flow and UW Health’s overall financial strength, providing excellent customer service. |

|Imbue the staff with a commitment to Customer Service and helpfulness to our patients. |

|Promote good public relations as a representative of the department and of UW Health in communicating with outside parties including patients/their guarantors and |

|third-party payers. |

|Be aware of and notify employees of changes in federal, state and/or third-party payor rules and regulations, department and hospital policies and system updates. |

|Contribute to the preparation and maintenance of weekly, monthly and annual reports identifying A/R by payer category and other Patient Accounts performance data. |

|Develop and maintain procedural documentation. Write and review reports to research specific work related issues such as employee, payor or system performance |

|problems, and to identify work flow improvements. |

|Coordinate activities performed by staff to optimize effectiveness and performance in accomplishing unit and department goals. |

|Draft, implement and instruct staff in new processes and procedures developed as a result of new technologies, new applications, new third-party contracts and/or payor |

|requirements, new/revised government regulations, new hospital programs and services. |

|Provide prompt and accurate responses to staff questions, problems or information needs regarding a variety of issues including changes in third party payor contracts, |

|and requirements of government rules and regulations. |

|Review and authorize internal adjustments and requests for refunds that result in a change of status in the patient’s account and UW Health’s A/R. Investigate |

|adjustments and refunds as necessary to assure that all appropriate efforts to resolve were successfully exhausted. Provide feedback to staff regarding errors in |

|refund and adjustment transactions. |

|Identify and resolve system and payor issues that result in payment delays, incorrect payments and/or increased credit balances. |

|Monitor status of staff workload through the use of ad hoc and system produced reports that identify weekly activity performed, trends in activity and impact of |

|unworked accounts. Provide feedback to staff regarding the status of assignments and instruction in processes that will resolve balances and meet or exceed best of |

|practice standards. |

|Serve as a Business Office liaison with other UW Health departments, third party payers, the public, state and federal agencies and other parties in a problem solving |

|or information capacity. |

|Participate in department sessions to explain billing and follow-up procedures and how the entry of information to various computer applications affects UW Health A/R. |

|Participate in weekly administrative meetings and monthly staff meetings. Attend seminars. |

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

|Interview and hire qualified job applicants |

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

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

|Formulate new processes and procedures in order to improve the efficiency of the unit. New processes and procedures may affect all fiscal personnel. |

|Develop training programs for Business Office personnel regarding: collection techniques and third-party payor payment requirements, operating needs, computer system |

|issues and laws and regulations relating to the performance of the unit/department. |

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

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

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

|Plan, organize and coordinate the activities of the unit. |

| |

|Performance Measures: |

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

|Complete and timely collection of patient accounts |

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

|Annual performance reviews |

| |

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

|JOB REQUIREMENTS |

|Education |Minimum |Associate degree in a relevant subject such as business, healthcare administration or related major (relevant |

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

| |Preferred |Bachelor’s degree in a business, healthcare administration or related major |

|Work Experience |Minimum |Three years of experience in a healthcare revenue cycle or at least 1 year of related experience in a |

| | |leadership role. |

| |Preferred |Three years management experience in healthcare revenue cycle operations for a large, complex health care |

| | |environment, including experience in an academic medical center. |

|Licenses & Certifications |Minimum | |

| |Preferred | |

|Required Skills, Knowledge, and Abilities |Ability to make good judgments in demanding situations |

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

| |Effective communication skills |

| |Ability to listen empathetically |

| |Ability to logically organize details |

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

| |start to finish |

| |Ability to manage multiple concurrent activities |

| |Effective organizational, planning, scheduling and project management abilities |

| |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 |

| |Effective communication skills both in written and verbal presentation with a communication style that is open|

| |and fosters trust, credibility and understanding. |

| |Ability to analyze data and workflows in order to develop and analyze options, recommend solutions, and solve |

| |complex problems and issues |

| |Strong customer service and human relations abilities |

| |Ability to effect collaborative alliances and promote teamwork |

| |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 is preferred including EPIC |

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

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

| |Knowledge of general accounting principles |

| |Knowledge of medical terminology |

| |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. |

|AGE SPECIFIC COMPETENCY (Clinical jobs only) |

|Identify age-specific competencies for direct and indirect patient care providers who regularly assess, manage and treat patients. |

|Instructions: Indicate the age groups of patients served either by direct or indirect patient care by checking the appropriate boxes below. Next, |

| |Infants (Birth – 11 months) | |Adolescent (13 – 19 years) |

| |Toddlers (1 – 3 years) | |Young Adult (20 – 40 years) |

| |Preschool (4 – 5 years) | |Middle Adult (41 – 65 years) |

| |School Age (6 – 12 years) | |Older Adult (Over 65 years) |

|JOB FUNCTIONS |

|Review the employee’s job description and identify each essential function that is performed differently based on the age group of the patient. |

| |

|PHYSICAL REQUIREMENTS |

|Indicate the appropriate physical requirements of this job in the course of a shift. Note: reasonable accommodations may be made available for individuals with |

|disabilities to perform the essential functions of this position. |

|Physical Demand Level |Occasional |Frequent |Constant |

| |Up to 33% of the time |34%-66% of the time |67%-100% of the time |

|X |Sedentary: Ability to lift up to 10 pounds maximum and occasionally |Up to 10# |Negligible |Negligible |

| |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. | | | |

| |Light: Ability to lift up to 20 pounds maximum with frequent lifting |Up to 20# |Up to 10# or requires |Negligible or constant |

| |and/or carrying of objects weighing up to 10 pounds. Even though the | |significant walking or |push/pull of items of |

| |weight lifted may only be a negligible amount, a job is in this | |standing, or requires |negligible weight |

| |category when it requires walking or standing to a significant degree.| |pushing/pulling of arm/leg | |

| | | |controls | |

| |Medium: Ability to lift up to 50 pounds maximum with frequent |20-50# |10-25# |Negligible-10# |

| |lifting/and or carrying objects weighing up to 25 pounds. | | | |

| |Heavy: Ability to lift up to 100 pounds maximum with frequent lifting |50-100# |25-50# |10-20# |

| |and/or carrying objects weighing up to 50 pounds. | | | |

| |Very Heavy: Ability to lift over 100 pounds with frequent lifting |Over 100# |Over 50# |Over 20# |

| |and/or carrying objects weighing over 50 pounds. | | | |

|List any other physical requirements or bona fide occupational qualifications:| |

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.

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