Provide expert knowledge and analysis of payer rules and regulations for hospital billing. Make decisions to enhance procedures and implement changes as needed to ensure optimal reimbursement with regulatory requirements. Assist the unit with providing information to Revenue Cycle leadership, Chairs and Clinical Department Administrators regarding issues related to reimbursement.
*This position is being posted and may be filled with an under fill title based on experience*
- Understand and interpret hospital reimbursement rules by payer and clinical specialty.
- Work with billing unit staff and payer representatives to facilitate resolution of reimbursement issues.
- Analyze CMS, Medicaid and other payer regulations related to billing for multiple clinical specialties and implement processes to ensure compliance with regard to specific payer system requirements.
- Identify and resolve payer reimbursement issues and underpayments.
- Analyze, evaluate, monitor and advise the Billing Unit Director, Revenue Cycle Director, Chairs and Clinical Department Administrators on pertinent issues regarding reimbursement.
- Assist Director with the development and implementation of policies, procedures and system improvements to ensure compliance with regulations and requirements across multiple clinical specialties.
- Monitor and report on reimbursement trends.
- Develop and implement strategies with other Revenue Cycle units pertaining to payer reimbursement changes.
- Review existing payer specific claim forms, system reports, dictionaries, payer files and other operational information in order to ensure clean claims.
- Prepare special periodic reports, including financial summaries, quality reporting and activity statistics.
- Resolve operating problems, patient and employee complaints pertaining to reimbursement related issues.
- Assist with the training of staff pertaining to reimbursement related issues.
- Act as a liaison with Health System departments, external agencies, customers, and vendors pertaining to reimbursement related issues.
- Assure compliance with institutional goals, objectives, policies, standards and guidelines.
- Model and reinforce a culture of service excellence to patients and families, internal colleagues and external customers.
- Assist departments with revenue projections as part of the ROI analysis for new clinical programs.
A Bachelor’s degree in Business Administration, Health Care Administration or related field, or an equivalent combination of education and experience is necessary. Progressively responsible experience in hospital medical billing and collection, or third party claims adjudication and regulation is necessary. The following is necessary: written and verbal communication skills, demonstrated ability to perform within a team environment, and knowledge of computer applications. Supervisory experience is preferred. Knowledge of University policies and procedures is desired.
- Bachelor or Masters Degree in Health or Business Administration or an equivalent combination of education and experience required. Considerable administrative experience necessary
- Extensive knowledge of cross-departmental hospital and physician billing policies, third party payer processes and regulatory and accreditation requirements a must
- Vast understanding of systems related to revenue cycle and health system billing, including but not limited to: MIChart and ePremis
- Significant experience using third party payer portals: WebDenis, CHAMPS, CSNAP, UHC Online, HAP, Priority Health, AARP, NaviNet, MARS and methods of obtaining e-referrals
- Experience with initiating and developing policies and procedures to enhance revenue capture and margin enhancement including the ability to prepare projections, analyses and plans for operational improvement
- Strong presentation and communication skills a must
- Ability to assist unit Director in the management of cross-departmental billing and collections including the monitoring of charges and collections and initiating corrective action when necessary
- Experience with team building and knowledge of incorporating Lean principles into daily work
- Must have an excellent attendance record
Michigan Medicine offers an excellent medical, dental and vision plan, 2:1 match on retirement savings, generous paid time off program and 75% tuition reimbursement.
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.
The University of Michigan Health System improves the health of patients, populations
and communities through excellence in education, patient care, community service, research and
technology development, and through leadership activities in Michigan, nationally and
internationally. Our mission is guided by Strategic Principles and has three critical components;
patient care, education and research that together enhance
our contribution to society.
Although the Posting End Date may indicate otherwise, this job opening may be filled and closed any time after a posting duration of seven calendar days.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.