Manager, Payor Analytics & Reimbursement

Job Summary

The Manager, Reimbursement and Payor Analytics will serve as the central connection point between Finance, Accounting, and Revenue Cycle leadership.

Responsibilities

• 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.
• 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.

Requirements

• Bachelor's degree in Healthcare Administration, Finance, or related field.
• Master's degree in related field and/or CPA preferred.
• 5+ years of healthcare experience, with at least 2 of those years in a reimbursement role.
• Background in hospital financial operations.
• Working knowledge of CMS regulations, cost reporting principles, and healthcare reimbursement methodologies.
• Familiarity with the full Revenue Cycle process and its implications on net revenue and accounts receivable valuation.
• Experience in Medicare Cost Report preparation and review.
• Experience with RCA or similar software for AR accounting and analysis.
• 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.
• Able to communicate effectively and work collaboratively with all levels of the organization.

Qualifications

• Full understanding of accounting principles relating to revenue and accounts receivable.
• Ability to manage multiple priorities in a fast-paced environment.

Benefits

N/A

Schedule

Hybrid work schedule