Reimbursement Manager

The Manager, Reimbursement & Cost Reporting is responsible for overseeing the preparation, review, and submission of Medicare, Medicaid, and CHAMPUS/TRICARE cost reports, including audit support, settlement activities, reopening requests, and appeal documentation. This position serves as a key subject matter expert on reimbursement regulations and collaborates closely with organizational leadership to evaluate the regulatory, operational, and financial impact of reimbursement-related decisions.

The Manager ensures compliance with all federal and state reimbursement requirements while driving the accurate and timely completion of all cost reporting activities. In this role, the Manager coordinates and leads audits associated with cost reports, communicates technical reimbursement positions to auditors and regulatory agencies, and ensures supporting documentation is maintained for Medicare and Medicaid reimbursement reporting, including Uniform Contractual Worksheet and Third-Party Settlement templates.

The position continuously monitors legislative and regulatory changes affecting healthcare reimbursement and analyzes their impact on the organization's financial performance. The Manager performs advanced financial analysis and modeling to assess reimbursement implications of proposed transactions, strategic initiatives, and regulatory changes. This individual serves as an internal resource for Medicare and Medicaid reimbursement matters, provides guidance to leadership, and develops recommendations to optimize reimbursement outcomes.

Additionally, the Manager trains, mentors, and supervises reimbursement staff, ensuring adherence to regulatory requirements, departmental standards, and best practices. The role also supports third-party financial statement reporting and other reimbursement-related financial analyses to promote operational effectiveness and financial integrity.

• Oversee the preparation, review, and submission of Medicare, Medicaid, and CHAMPUS/TRICARE cost reports.
• Provide audit support, settlement activities, reopening requests, and appeal documentation.
• Serve as a key subject matter expert on reimbursement regulations.
• Collaborate closely with organizational leadership to evaluate the regulatory, operational, and financial impact of reimbursement-related decisions.
• Ensure compliance with all federal and state reimbursement requirements.
• Coordinate and lead audits associated with cost reports.
• Communicate technical reimbursement positions to auditors and regulatory agencies.
• Maintain supporting documentation for Medicare and Medicaid reimbursement reporting.
• Monitor legislative and regulatory changes affecting healthcare reimbursement.
• Perform advanced financial analysis and modeling to assess reimbursement implications.
• Provide guidance to leadership and develop recommendations to optimize reimbursement outcomes.
• Train, mentor, and supervise reimbursement staff.
• Support third-party financial statement reporting and other reimbursement-related financial analyses.

• Bachelor's degree in Accounting, Finance, Healthcare Administration, or related field.

• In-depth knowledge of Medicare and state Medicaid reimbursement laws and regulations.
• Demonstrated experience preparing and filing Medicare and Medicaid cost reports.
• Ability to research, interpret, and apply complex Medicare and Medicaid regulations.
• Experience coordinating reimbursement audits and responding to auditor inquiries.
• Proficiency with regulatory cost reporting software.
• Strong understanding of financial accounting, auditing principles, and their application within healthcare organizations.
• Advanced financial analysis and financial modeling skills.
• Strong Microsoft Office skills, including Excel for data analysis and reporting.