Reimbursement Policy Manager (TMS)

Schedule: Full-time

BWC’s core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC’s seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.

What You’ll Be Doing:

Independently manages Ambulatory Surgery Center (ASC) or other assigned fee schedules, IPPS, OPPS, PPMS) payment program development & maintenance taking into to account relevant National (i.e., Medicare) and private payer’s methodologies.

Plans, directs, develops & implements relevant medical and reimbursement policies in order to maintain an accurate, efficient, effective, and appropriate ASC reimbursement methodology.

Monitors & analyzes operations, systems & procedures to ascertain appropriate improvements & feasibility & or impact of assigned fee schedule reimbursement system on administrative functions.

Execute MCO and provider trainings to facilitate appropriate billing and administration of the assigned fee schedule.

Serve as the lead responder on inquiries and/or reimbursement approval requests submitted to the Medical Policy mailbox for the ASC reimbursement methodology or other assigned fee schedule.

To Qualify, You Must Clearly Demonstrate:

Required Experience and/or Education:

Completion of graduate core program in health care administration; 12 months experience in medical policy development for medical provider or insurance company.

Or completion of undergraduate program core coursework in pre-medicine, allied medical field, nursing or related field of study; 12 months practical experience in health care field; 12 months experience in writing medical policies & procedures for medical provider or insurance company.

Or certified medical coder in current procedural terminology (CPT) hospital coding, or current ICD coding system; 12 months experience in writing medical policies & procedures for medical provider or insurance company; 12 months practical experience in health care field.

Or equivalent of Minimum Class Qualifications for Employment noted above.