Reimbursement Manager

Overview

• Manage reimbursement functions across multiple healthcare facilities, ensuring compliance with regulations and accurate accounting practices.
• Oversee monthly contractual income statements and balance sheet accounts for diverse programs and facilities.
• Coordinate cost report preparation, submission, and audits to maximize reimbursement opportunities.
• Provide financial analysis and regulatory insights to support operational decisions and compliance.
• Collaborate with external auditors and internal teams to ensure accurate reporting and settlements.
• Develop and maintain policies for standardized reimbursement processes and transparent operations.
• Support corporate initiatives and projects requiring reimbursement expertise.
• Actively participate in professional organizations to stay updated on industry trends.

Key Responsibilities & Duties

• Prepare and review monthly journal entries and calculations for contractual allowances.
• Analyze variances in contractual allowances and provide detailed explanations to administration.
• Ensure timely and accurate submission of cost reports to prevent reimbursement losses.
• Coordinate Medicare field audits and review adjustments to ensure proper settlements.
• Prepare appeals and position papers for inappropriate settlements with regulatory boards.
• Assist in operational decision-making by analyzing financial impacts and regulatory changes.
• Monitor interim payment rates and collaborate with intermediaries to ensure accuracy.
• Participate in initiatives to track and reduce denials and address contract rate issues.
• Support cross-functional teams for system standardization and reimbursement expertise.

Job Requirements

• Bachelor’s degree in a relevant field is required.
• Minimum of 7 years of experience in reimbursement management or related roles.
• Proficiency in preparing and analyzing financial statements and cost reports.
• Strong knowledge of Medicare, Medicaid, and other third-party reimbursement regulations.
• Experience in coordinating audits and appeals with regulatory bodies.
• Excellent analytical and problem-solving skills to support operational decisions.
• Ability to collaborate with cross-functional teams and external auditors effectively.
• Commitment to maintaining compliance and integrity in all processes.
• Active participation in professional organizations such as HFMA is preferred.