A reimbursement manager handles medical bills and communicates with insurance companies or government agencies to receive payments. They are skilled in medical coding and must comply with HIPAA regulations. They are a valuable part of a medical practice’s financial health.
A reimbursement manager is usually responsible for managing medical bills in order to receive third-party payments. In many cases, this means communicating with insurance companies or government agencies that provide medical insurance to some citizens. A reimbursement manager will be experienced in various aspects of handling medical records in order to facilitate payments to the provider.
While many hospitals and other facilities have specific claims management positions in their hierarchy, the truth is that a variety of finance and insurance individuals work to obtain claims. Some of these workers may have a certification in medical coding and record handling, and some may not. Some focus on correcting errors in actual medical claims, while for others, the job of connecting with insurance company representatives is primary. Most repayment managers, however, practice these two strategies together to get payments on overdue accounts.
The reimbursement manager is usually “fluent” in different types of medical coding. For example, the ICD9 and ICD10 international coding used for diagnostics is something most claims managers will be familiar with. The reimbursement manager may also be skilled in interpreting CPT or HPCT codes, procedure codes for different medical treatments. Both codes can contribute to accurate medical bills and timely reimbursement by insurance companies or others.
The reimbursement manager is usually part of a larger medical practice. A provider may have a specific work area for claims managers or consider them part of a separate department. In some cases, the entire department may be one individual, especially in a smaller practice. Reimbursement managers work in a number of different settings to facilitate receivables and receivables and help medical providers stay in business.
One of the biggest restrictions on reimbursement managers involves the Health Insurance Portability and Accountability Act, or HIPAA. This legislation protects patient information and requires accurate handling of all medical records. As a reimbursement manager deals a lot with data protected by HIPAA, he or she is likely to face some challenges in maintaining full compliance with the spirit of this law. All records must be secure at all times, and medical practices often struggle to provide their reimbursement managers with all the necessary safeguards to ensure that HIPAA is always a primary consideration and that compliance fails.
As all medical providers need cash to stay in business, reimbursement managers are often a highly valued part of the overall workplace. Considering the ways that different medical practices employ these professionals, it can tell the observer a lot about the overall financial health of a specific facility. To be effective, claims managers need to be trained and skilled in handling and evaluating records, as well as other critical aspects of the job.
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