Reimbursement Manager

The Reimbursement Manager oversees the preparation, analysis, compliance, and optimization of government and third-party reimbursement programs. This role is responsible for ensuring all annual Medicare, Medicaid, and state cost reports are accurate, compliant with federal and state regulations, and filed timely. The Manager monitors regulatory changes, directs internal and external audit responses, conducts multi-year financial forecasting, and leads a high-performing team of analysts to safeguard and optimize the organization’s financial performance.

Essential Functions & Performance Allocation

• Regulatory Cost Reporting & Compliance (30% of Time)
• Medicare & Medicaid Filings: Prepare, analyze, and review annual system-wide Medicare and Medicaid cost reports to ensure total accuracy and regulatory alignment.
• Optimization Strategies: Identify and implement compliant opportunities to streamline reporting processes and optimize organizational reimbursement under evolving government program regulations.
• Audit & Appeals: Monitor, file, and systematically follow up on reimbursement appeal opportunities. Ensure all cost reports strictly adhere to state and federal statutes.
• Documentation Management: Prepare and maintain all complex financial schedules, workpapers, and data analyses that support regulatory filings.
• Third-Party Reporting & Financial Analysis (25% of Time)
• Specialized Filings: Prepare and review State Medicaid disproportionate share hospital (DSH) shortfall filings, third-party cost reports, and recovery audit contractor (RAC) reserves.
• Federal Register Monitoring: Track and analyze ongoing changes in DRG (Diagnosis-Related Group) reimbursement rates, case-mix indexes, weightings, cost outliers, and capital updates to ensure continuous compliance with the Federal Register.
• Financial Accountability: Review and prepare quarterly social accountability calculations, third-party analysis for auditors, and monthly account reconciliations to ensure financial integrity.
• Strategic Forecasting, Project Management & Administration (20% of Time)
• Multi-Year Forecasting: Conduct comprehensive, multi-year financial forecasting modeling for government reimbursement programs to inform executive decision-making.
• Executive Presentation: Standardize system-wide cost report insights and data analysis to socialize key findings with executive leadership teams.
• Fiscal Control: Develop, implement, and manage departmental policies and operating budgets, ensuring precise cost control and alignment with organizational expense goals.
• Project Oversight: Direct and monitor specialized reimbursement projects to ensure accurate completion within established timeframes and budgets.
• Audit Coordination (10% of Time)
• Audit Facilitation: Lead and coordinate internal and external audit activities, serving as the primary point of contact and ensuring the timely delivery of requested support schedules.
• People Management & Team Leadership (15% of Time)
• Team Supervision: Directly supervise, mentor, and manage the performance of the reimbursement analyst team through ongoing coaching, structured feedback, and professional development.
• Talent Management: Drive the full talent lifecycle for direct reports, including workforce planning, interviewing, making hiring decisions, executing performance evaluations, and managing disciplinary actions.
• Culture & Engagement: Foster a collaborative, motivated, and high-performing team environment focused on accuracy, compliance, and continuous process improvement.
• Must Have Skills/Experience:
• 8 years experience in healthcare Accounting/Finance
• 8 years experience in Medicare/Medicaid cost reporting
• 3 years experience in supervisory role
• Proficient in Excel
• Preferred Skillset/Experience:
• Experience in healthcare reimbursement consulting
• Experience in healthcare reimbursement in muti-hospital health system
• CPA or MBA