Reimbursement Manager

Job Description Summary

Responsible to direct, review and evaluate the work of the Reimbursement, and Managed Care Contracting and to assist the Senior Vice President/CFO and other Administrators/Department Managers in matters related to, reimbursement, and Managed Care Contracting.

Job Description

Key Responsibilities:

1. Oversees preparation of annual cost reports
a. Cost reports are filed in required time frames.
b. Reports are prepared with accuracy and ensure all revenues the system is entitled to.
c. Stays current on rules and regulations, interprets with regard to cost reports.

2. Monthly contractual allowances
a. Prepares monthly report with changes in net revenue analysis and prepares third-party liability estimates

3. Maintains estimates that are accurate recommending reserve levels.

4. Flags variances of both positive and negative impact on operations to Senior Management on a timely basis.
a. Provides easily understood explanation and analysis of net revenue

5. Reviews monthly reports and ensures reports are accurate, timely and easily understood.

6. Coordinates appeals and represents Hospital at regulatory board when required. Appeals findings where appropriate. Develops strategies on reimbursement issues and ensures strategies (i.e., documentation, etc.) are followed by Operations Departments where applicable.

7. Oversees Managed Care Contracting for on–SSHPO contacts for managed care and commercial contracting.
a. Acts as participant in SSHPO and Hospital contracting for major risk contracts

8. Provides payment estimates and other relevant estimates to support business planning and pro-forma development.

9. Responsible for department’s operational excellence; assures department delivers quality services in accordance with applicable policies, procedures and professional standards. Manages all activities so that quality services are provided in an efficient and effective manner, as observed by Executive Director of Finance.

10. Attains all agreed to goals and objectives within specified time frames, as part of the organization’s overall mission.
11. Manages human resources to assure quality services and promote positive employee relations.

12. Responsible for the fiscal management of department; assures proper utilization of organization’s financial resources

13. Prepares presentations to Senior Management. Assists in developing major assumptions. Reviews impact of assumptions and changes if required. Presents materials in logical, accurate format for review with Senior Management. Coordinates annual budget retreat. Reviews impact of new programs with Senior Management. Holds seminars or informational sessions on major changes on reimbursement and payment to Administrative Team/Department Managers whenever applicable.

I. Technology and Learning
a. Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.
b. Embraces technological advances that allow us to communicate information effectively and efficiently based on role.

Job Requirements:
Minimum Education - Preferred
BS in either Accounting, Finance or Business Administration preferred.

Minimum Work Experience
A minimum of eight to twelve (8–12) years of accounting experience in the healthcare field is preferred, at least four (4) years of which must be directly in the field of third-party reimbursement.