Manager Reimbursement - Accounting

About the Role

The Reimbursement Manager ensures proper payments from Third Party programs and maintains accurate accounting of these programs. This role involves managing the reimbursement function for multiple facilities, which may include acute care, rehabilitation units, psychiatric units, skilled nursing facilities, medical education, End Stage Renal Disease, Organ Acquisition, and Medicare Disproportionate Share/Uncompensated Care. The position also supports the Corporate Reimbursement Department on various projects, including regulatory and financial analysis.

Responsibilities

• Prepare and review monthly third-party settlement journal entries and supporting calculations, ensuring proper balances in associated income statement and balance sheet accounts for multiple facilities (Medicare, Medicaid, and Tricare).
• Analyze monthly third-party settlement allowance variances and provide detailed explanations for significant fluctuations to Hospital Administration for use during close meetings.
• Maintain current and correct account analyses related to program Income Statement and Balance Sheet accounts.
• Ensure monthly settlement models are prepared timely and accurately by supporting departmental Associates.
• Assist and review monthly third-party settlement templates, Uncompensated Care template, and reimbursement entries in the Cash to Net spreadsheet for accuracy.
• Maintain proficiency in software tools (e.g., Toyon Absolute Solution, HFS cost report software, HFS IRIS, STRATA) and assist in educating Reimbursement staff as needed.
• Prepare final hospital and home office cost reports, completing comparative analysis of the cost report versus the financial statement and compliance checklist prior to submission for multiple facilities.
• Ensure Medicare, Medicaid, and CHAMPUS cost reports are submitted by due dates to prevent loss of reimbursement.
• Identify and pursue proper reimbursement methodologies to receive all reimbursement due based on Medicare, Medicaid, and CHAMPUS Regulations.
• Coordinate Medicare Field Audits, ensuring complete, proper, and timely information is provided, and review audit adjustments prior to issuance of the settlement.
• Prepare audit adjustment analysis to determine the reimbursement impact of adjustments to the as-filed report.
• Work with System associates to prepare and submit cost report reopening requests to obtain additional reimbursement due and make requests for corrections as appropriate.
• Prepare and submit appeals and subsequent position papers to appeal inappropriate settlements with the PRRB for assigned facilities.
• Assist in preparation of Social Accountability and Community Needs reports required as part of the annual budget process.
• Assist department leadership in analyzing the financial impact of operational decisions, including preparation of pro-forma analysis and due diligence for new and existing business opportunities.
• Inform Management and Hospital Administration of proposed/final rules and Regulations that could impact hospital operations.
• Assist in maintaining rate tables for Medicare, Traditional Medicaid, and CHAMPUS to ensure proper payments are received.
• Monitor interim payment rates and work with the Intermediary to ensure proper payments are being made.
• Collaborate on cross-functional teams to address System standardization needs where reimbursement expertise is required.
• Assist Accounting and Business Office departments with the cash reconciliation process for settlements and interim payments, including identifying and communicating errors or issues.
• Maintain knowledge of current trends and developments in the field by reading appropriate books, journals, and attending related seminars and conferences.

Requirements

• Bachelor’s degree in Business Administration, with a major in Accounting, Finance, or Business.
• Minimum of five years of experience in increasingly responsible positions in Third Party Reimbursement, including Medicare Intermediary and hospital Reimbursement experience.

Schedule

8 AM – 5 PM, Monday through Friday.

Work Type

Full Time.