Reimbursement Manager

Industry: Hospitals and Health Care

Are you an experienced healthcare reimbursement professional with deep expertise in Medicare cost reporting, audits, and regulatory compliance? This role offers the opportunity to influence reimbursement strategy, maximize revenue recovery, and provide critical financial insights supporting hospital operations and leadership decision-making.

A Manager Reimbursement - Accounting to oversee Medicare, Medicaid, TRICARE, and other third-party reimbursement programs while ensuring accurate financial reporting, regulatory compliance, cost report preparation, and reimbursement optimization across multiple healthcare facilities.

The Reimbursement Manager is responsible for managing reimbursement activities across multiple healthcare facilities, including:

• Rehabilitation Units
• Psychiatric Units
• Skilled Nursing Facilities (SNFs)
• Medical Education Programs
• End-Stage Renal Disease (ESRD) Services
• Uncompensated Care Programs

This role also supports enterprise-wide reimbursement initiatives, regulatory analysis, financial projects, reimbursement optimization efforts, audits, appeals, and healthcare policy impacts.

• Prepare and review monthly third-party settlement journal entries and supporting analyses.
• Medicaid
• TRICARE/CHAMPUS
• Uncompensated Care Programs
• Maintain accurate balances across reimbursement-related income statement and balance sheet accounts.
• Analyze settlement variances and provide detailed explanations to hospital leadership.
• Monitor reimbursement reserves and ensure proper monthly close activities.

• Prepare and review Medicare, Medicaid, Home Office, and CHAMPUS cost reports.
• Perform detailed reconciliations between financial statements and cost reports.
• Ensure all regulatory filings are completed accurately and submitted by required deadlines.
• Apply regulatory reimbursement methodologies to maximize reimbursement opportunities.
• Maintain compliance with federal and state healthcare reimbursement regulations.

• Coordinate Medicare field audits and reimbursement reviews.
• Prepare audit support documentation and respond to auditor requests.
• Review audit findings and settlement calculations to ensure accuracy.
• Communicate discrepancies and reimbursement concerns to auditors.
• Analyze audit adjustments and determine financial impacts on healthcare facilities.

• Prepare and submit:
• Cost Report Reopenings
• Appeals
• Position Papers
• Reimbursement Correction Requests
• Pursue reimbursement opportunities to ensure organizations receive all eligible payments.
• Identify opportunities for reimbursement improvements and revenue enhancement.

• Support leadership with financial and reimbursement impact analyses.
• Conduct:
• Reimbursement Forecasting
• Operational Impact Analysis
• Evaluate proposed regulatory changes and communicate financial implications.
• Provide recommendations that support strategic operational and financial decisions.

• Maintain Medicare, Medicaid, and TRICARE reimbursement rate files.
• Monitor interim reimbursement rates and payment activity.
• Coordinate with fiscal intermediaries and payers to resolve payment discrepancies.
• Ensure facilities receive appropriate payments and adjustments.

• Partner with:
• Accounting Teams
• Revenue Cycle Departments
• Business Offices
• Hospital Administration
• Finance Leadership
• Support cash reconciliation activities related to settlements and interim payments.
• Assist with reimbursement expertise on system-wide standardization initiatives.
• Contribute to annual budget development and community benefit reporting.

• Stay current on healthcare reimbursement trends, regulations, and industry developments.
• Attend seminars, conferences, and professional development events.
• Provide guidance and education to reimbursement staff and stakeholders.
• Support ongoing process improvements and operational excellence initiatives.

• Bachelor's Degree in:
• Accounting
• Finance
• Business Administration
• Related Discipline

• Minimum 5 years of progressive healthcare reimbursement experience.