CDI Reimbursement Manager

The Medical College of Wisconsin•Wauwatosa, WI

2d•Onsite

About The Position

The CDI Managing Liaison serves as a strategic partner within the Clinical Documentation Integrity (CDI) program, collaborating closely with Clinical Departments and CPS teams. This role advances the CDI mission by optimizing professional billing and reimbursement through the integration of front‑end operations to reduce denials and revenue leakage. Embedded within the CDI structure, the Managing Liaison works with department leadership, clinicians, revenue cycle partners, and ancillary services to identify and implement process improvements that enhance the overall revenue cycle experience. The role ensures documentation integrity, operational efficiency, and compliance with regulatory and billing standards while supporting accurate representation of the care delivered.

Requirements

Comprehensive understanding of clinic operations, professional billing workflows, reimbursement practices, and revenue cycle management.
Strong knowledge of procedure coding, CPT/HCPCS codes, use of modifiers, payer policies, and documentation standards.
Working knowledge of insurance and managed care principles, including pre-authorizations, referrals, and payer requirements.
Proficiency in electronic medical records (EMR) systems and professional fee billing platforms ability to extract and analyze clinical and financial data.
Advanced proficiency in Microsoft Office products; ability to create and interpret complex reports and data sets.
Knowledge of quality control, customer service standards, information management, procedural processes, and recordkeeping practices.
Strong analytical and critical thinking skills, with the ability to identify trends, investigate issues, and develop actionable solutions.
Excellent written and verbal communication skills, including the ability to present complex information clearly to diverse audiences.
Effective interpersonal and listening skills, with a professional and confident demeanor in interactions with clinicians, staff, and leadership.
Ability to manage multiple tasks and priorities simultaneously, demonstrating flexibility and adaptability in a dynamic healthcare environment.
Experience conducting audits, preparing reports, and supporting appeals and reimbursement initiatives.
Ability to provide education and training to clinicians, residents, and staff on billing, coding, documentation, and reimbursement processes.
Diligence and accuracy, especially in reviewing financial data, coding practices, and billing documentation.
Patience and diplomacy in resolving sensitive or complex issues across departments and with external stakeholders.
Capacity to lead and participate in improvement initiatives, policy development, and special projects related to reimbursement and charge capture.
Bachelor’s degree or equivalent experience
5 years Professional service coding experience.
Application of payer policy review.
Coding certification through AHIMA or AAPC

Nice To Haves

Specialty coding certification in one or more specialty from AHIMA or AAPC
Professional revenue cycle specialty coding experience.

Responsibilities

Collaborate with Clinical Departments, CPS, and CDI leadership to identify and resolve clinical and financial concerns related to coding, documentation, charge capture, billing, and reimbursement.
Evaluate opportunities to improve coding accuracy, documentation quality, and charge capture processes to ensure compliant and accurate reimbursement
Coordinate and collaborate activities related to CDI, CPS, and Enterprise Registration for workflow improvement opportunities.
Function as a process improvement liaison between CPS teams and clinicians, to improve tactics for seamless billing and collection processes.
Analyze accounts receivable (AR) and financial reports, including monthly write-off reports, ad hoc reports, and physician logs, to identify trends, summarize outcomes, and track key performance indicators relevant to CDI initiatives.
Monitor charge and payment report to ensure appropriate workflow for services rendered.
Investigate and escalate follow up on encounters, coordinating with billing specialists and reimbursement teams to resolve discrepancies and ensure timely collections.
Identify billing and reimbursement issues, develop improvement initiatives, and implement action plans to reduce write-offs and enhance revenue, supporting CDI-driven documentation improvement efforts.
Provide ongoing training and education to clinicians, residents, and clinical support staff on professional billing practices, coding guidelines, documentation standards, use of modifiers, and payer policies, in collaboration with CDI.
Support billing-related activities, including epic enhancements for accurate reimbursement, denials avoidance.
Advise on cost and package in appropriate instances.
Participate in billing meetings and committees to represent CDI and departmental interests, contributing to system-wide improvements.
Lead and support special reimbursement projects as assigned in coordination with CDI initiatives.
Prepare and support appeal creation and submission for denied claims, utilizing standard system reports and self-generated analyses in alignment with CDI documentation standards.
Collaborate with CPS teams/leaders to maintain and enhance departmental policies and procedures related to complex or sensitive billing and reimbursement issues and ensure alignment with CDI protocols.
Serve as the primary point-of-contact for department leaders and faculty regarding coding, billing, documentation, denials, reimbursement, and payer policies, under the CDI team’s guidance with dissemination and connecting of CDI and CPS resources and support.
Collaborate with CPS and others to ensure accurate charge capture setup for new services and CPT codes.
Provide clinical coding support and education to coding, including evaluation of tools and resource deployment.
Participate in new provider orientation to convey expected provider support available from CDI team.
Share applicable provider tools and resources available that will optimize documentation practices and efficacies.
Safeguard and strengthen relationships with internal and external stakeholders to support departmental financial health and CDI objectives.
Perform other duties as assigned to support the overall goals of the department and organization.

Benefits

Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental.
Flexible Spending options
403B Retirement Package
Competitive Vacation and Paid Holidays offered
Tuition Reimbursement
Paid Parental Leave
Employee & Family Assistance Program (EFAP)
Pet Insurance
On campus Fitness Facility, offering onsite classes
Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.