Manager, Reimbursement & Payor Analytics

The Manager, Reimbursement And Payor Analytics Will

• Serve as central connection point between Finance, Accounting, and Revenue Cycle leadership
• Work with Finance leadership to develop and implement reimbursement strategies across all payor types including Medicare, Medicaid, and commercial insurance
• Monitor legislative and regulatory changes affecting Medicare/Medicaid reimbursement, model and communicate expected impact, and implement necessary strategies
• Through partnership with a third party, generate and analyze detailed AR reports using RCA software to identify trends, bottlenecks, and manage the net AR month end accounting close process
• Play key role in the development, review, and submission of annual Medicare/Medicaid cost reports, ensuring accuracy and compliance with CMS guidelines and regulations
• Coordinate with external auditors during Medicare/Medicaid audits and respond to audit findings
• Partner with Revenue Cycle leadership to implement and manage Medicare bad debt policy and procedures.
• Analyze KPIs for accounts receivable, bad debt, denials, and collection rates
• Provide financial & strategic support in payor contract negotiations to optimize payment terms
• Assist in the review of annual CDM price increase process
• Provide reimbursement expertise in strategic financial modeling (new partnerships, expansion, etc.)
• Present complex financial information to senior leadership and provide strategic recommendations

Reports to Vice President, Financial & Strategic Insight

• Bachelor's degree in Healthcare Administration, Finance, or related field
• Master's degree in related field and/or CPA preferred
• Background in hospital financial operations with 5+ years of healthcare experience, with at least 2 of those years in a reimbursement role being strongly preferred; advanced degrees and/or specific relevant experience can substitute for total years of experience.
• Working knowledge of CMS regulations, cost reporting principles, and healthcare reimbursement methodologies
• Working knowledge of the full Revenue Cycle process and implications on net revenue and accounts receivable valuation
• Familiarity with healthcare billing and coding practices and technologies
• Experience in Medicare Cost Report preparation and review preferred
• Experience with RCA or similar software for AR accounting and analysis preferred
• Strong understanding of hospital operations and healthcare financial management
• Experience with electronic health record (EHR) systems
• Excellent analytical and problem-solving abilities
• Strong interpersonal and negotiation skills
• Ability to communicate effectively and work collaboratively with all levels of the organization
• Full understanding of accounting principles relating to revenue and accounts receivable
• Ability to manage multiple priorities in a fast-paced environment

• Normal office environment with little or no exposure to dust or extreme temperature.
• Hybrid schedule

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.