Reimbursement Manager

As the Reimbursement Manager the roles and expectations of the position include collection, analysis and reporting of accounting information for reimbursement with the knowledge, intensity and responsibilities as specified on the attached Job Description.  Willingly performs other duties as requested.

Roles and Responsibilities

1. Demonstrates an understanding of the rationale behind key reimbursement policies to allow for the development of appeal strategies, where possible, to protect the hospital’s financial interests.
2. Ensures that all reporting requirements are accurately submitted and on a timely basis.  Any amendments to data previously submitted are brought to the attention of the Director of Reimbursement & Financial Analysis and CFO.
3. Ensures that cost reports and special projects are analyzed for reasonableness and are documented in a neat and logical format.
4. Develops modeling techniques to allow for comparative analysis of projects thereby ensuring that reimbursement is maximized and any related interests of the hospital are protected.
5. Follows up on completed assignments by verifying that information has been received, clarifying issues and or answering questions, and documenting the status for future reference. (i.e. appeals)
6. Maintains the work paper files for all cost reporting projects, insures that documentation is auditable, easily accessible, and filed on a timely basis.
7. Demonstrates an understanding of the contractual allowances section of the income statement to identify changing trends in reimbursement.
8. Reviews and analyzes monthly revenue proof comparing expected reimbursement to the net revenue in the general ledger.  Provides explanations for variances and/or adjustments when deemed necessary.
9. Demonstrates a comprehensive knowledge of reporting requirements for all third party payors to include: Medicare and Medicaid, ICR, and the Champus Cost Report.
10. Responsible for the overall operations, leadership, direction and coordination of staff within the designated area(s) of responsibility
11. Coordinates department activities and interactions with other departments on an on-going basis
12. Attends and actively participates in hospital or medical performance improvement councils and committees as requested
13. Proactively communicates with staff and keeps them informed on a regular basis or as needed; updates staff regarding policy changes in specialized areas.
14. Develops and utilizes department policy statements, scop of service, quality indicators and updates; revises as necessary
15. Performs staff management functions related to employee selection, onboarding/orientation, coaching/development, staffing, work assignments, performance management and goal alignment as guided by hospital policy and procedures and collective bargaining unit agreement.
16. Participates, collaborates and actively engages in meetings to achieve goals and mutually beneficial outcomes
17. Conducts regular staff meetings to disseminate hospital and/or department/division information and allows for discussion of staff concerns needing clarification or resolution
18. Assumes other duties as assigned

Education/Experience/Certification Requirements

Required:

• Bachelor's Degree in a related field
• 3 years cost report experience

Preferred:

• Masters Degree 
• Previous leadership experience