Manager - Reimbursement - Physicians Professional Services
Categories: Professional, Insurance / Billing
Department: University Hospitals
Full/Part Time/PRN: Full-Time
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
Experience and Education
Bachelor’s degree in accounting, business administration, finance or related field required. Master’s degree, nursing license, or CPA preferred.
Experience and in-depth knowledge of health care finance/billing/coding required. Direct experience in a Multi-Specialty physician practice or other large physician practice preferred.
An equivalent combination of education and experience may be considered in lieu of stated education/experience.
Provides assistance and training to faculty and staff on coding, billing, and payment issues.
Acquires and maintains thorough knowledge of federal and state legislative and regulatory actions affecting physician and professional provider reimbursement; communicates acquired knowledge with faculty and staff.
Chairs the University Edit Administration Committee and provides advice/guidance on CPT/ICD-10 coding edit requests submitted by the clinical departments and/or the School of Health Professions.
Assists Patient Financial Services with maintenance of existing CPT/ICD-10 coding edits for Health System professional billing to ensure accuracy and compliance with applicable rules, regulations, policies, etc.
Analyzes monthly Health System denial reports related to professional services billing; reviews for proper coding, unbundling, concurrent care, modifiers, and compliance to ensure appropriate reimbursement.
Prepares and disseminates analyses of important regulation and/or managed care contract changes to patient financial services, clinical departments, the School of Health Professions, and to applicable oversight/compliance committees.
Develops, implements, and evaluates University, departmental, and/or School of Health Professions policies and processes related to reimbursement, coding, and billing methodologies.
Assures the correct identification, system installation (e.g., Epic, other support systems, etc.), and communication of reimbursement methodologies for all government payers.Must develop and maintain knowledge of applicable system sources and related requirements.
Develops timely and accurate models of proposed and/or approved changes in coding/reimbursement methodologies to determine financial impact.This requires independent research and the ability to identify appropriate information sources.
Extracts large data sets to identify and/or select key information for use by other team members.Supports business planning and decision support for senior leadership.
Performs other duties as assigned.
**Other Duties: Performs other duties as assigned.
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.