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What does a Reimbursement Manager do?

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  • Written By: A. Leverkuhn
  • Edited By: Andrew Jones
  • Last Modified Date: 12 November 2016
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A reimbursement manager is generally in charge of handling medical accounts in order to get payment from third parties. In many cases, this means communicating with insurance companies or the government agencies that provide medical insurance to some citizens. A reimbursement manager will be skilled in various aspects of medical records handling in order to facilitate payments to the provider.

Although many hospitals and other facilities have specific reimbursement management job positions in their hierarchy, the truth is that a range of financial and insurance handling individuals work on getting reimbursements. Some of these workers may have a certification in medical coding and records handling, and others do not. Some focus on correcting errors on actual medical claims, while for others, the job of connecting with insurance company representatives is primary. Most reimbursement managers, though, practice both of these strategies together to get payments made on overdue accounts.

The reimbursement manager is often “fluent” in different kinds of medical coding. For example, the ICD9 and ICD10 international coding used for diagnosis is something that most reimbursement managers will be familiar with. The reimbursement manager may also be skilled in interpreting CPT or HPCT codes, procedural codes for different medical treatments. Both of these codes can contribute to accurate medical bills and timely repayment by insurers or others.

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The reimbursement manager is most often part of a larger medical office. A provider may have a specific work area for reimbursement 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 many different setups to facilitate incoming accounts receivable to 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 treatment of all medical records. Because a reimbursement manager deals so much with HIPAA protected data, he or she will likely 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 with providing their reimbursement managers all of the necessary safeguards to make sure that HIPAA is always a prime consideration and that no lapses in compliance occur.

Since all medical providers need money coming in to stay in business, reimbursement managers are often a very valued part of the overall workplace. Considering the ways that different medical offices employ these professionals can tell an observer a lot about the overall financial health of a specific facility. In order to be effective, reimbursement managers have to be trained and skilled in records handling and assessment, as well as other critical aspects of the job.

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