Reimbursement Manager

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Manages the system-wide Medicare and Medicaid cost reports to secure appropriate reimbursement from these programs while ensuring hospitals adhere to internal reimbursement policies and procedures.

• Analyzes Medicare and Medicaid regulations and guides hospital operations to comply with government payment regulations.

• Thoroughly evaluates proposed adjustments to cost reports and collaborates with the Director and Vice President to determine which adjustments should be contested.

• Creates processes necessary for completing cost reports and securing payments for all programs and services.

• Formulates strategies and implements processes to ensure hospitals adhere to Medicare and Medicaid regulations.

• Accountable for the accuracy of Medicare and Medicaid cost report submissions across the system.

• Provides expert advice on compliance with Medicare and Medicaid reimbursement and payment regulations.

• Recognizes opportunities to maximize reimbursement for all services and programs provided.

• Engages in cost report appeals and participates in group appeals for cost reports.

• Assists in the revenue budgeting process for items where reimbursement is based on the cost report.

• Reviews third-party settlements monthly and updates them in accordance with monthly and fiscal year closing schedules.

• Oversees the hiring, training, and performance management of colleagues.

• Occasionally visits hospitals to ensure compliance with cost reporting data collection requirements and to address questions or operational challenges.

⛳️ Requirements

• Bachelor's Degree in Accounting, Finance, or a related discipline.

• 5 years of experience in interpreting Medicare and Medicaid payment regulations and completing cost reports for these programs.

• 5 years of experience in recording revenue and determining cost settlement receivables/payables related to Medicare and Medicaid payments.

• 3 years of experience in a hospital or acute care setting.

• Proficient in MS Office Suite with advanced skills.

• Capable of training staff on technology and hospital reimbursement concerns.

• Ability to thrive in a fast-paced environment.

• Skilled in reviewing large volumes of data.

• Capable of working independently.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible working hours

• Paid time off

• Professional development opportunities