Manager, Reimbursement

A Brief Overview
The Manager, Reimbursement is responsible for the strategic oversight, analysis, compliance, and optimization
of all third-party reimbursement activities for the health system. This role leads Medicare, Medicaid, Tricare, and
other governmental reimbursement programs; oversees cost reporting and reimbursement accounting;
evaluates regulatory and payment model changes; and partners with Finance, Revenue Cycle, Government
Relations, Physician Services, and Graduate Medical Education (GME) leadership to maximize reimbursement
opportunities while ensuring regulatory compliance. The position serves as the organization's subject matter
expert on healthcare reimbursement methodologies, reimbursement accounting, government payment
programs, and reimbursement-related financial analytics. The Manager leads reimbursement staff, supports
organizational financial planning, and provides strategic recommendations to senior leadership regarding
revenue optimization and reimbursement risk.

What You Will Do

Reimbursement Strategy & Compliance
* Direct and oversee all reimbursement functions in compliance with federal, state, and payer
regulations.
* Monitor Medicare, Medicaid, Tricare, commercial payer, and other reimbursement programs for
regulatory and financial impact.
* Assess the financial implications of proposed regulatory, reimbursement, and payment model changes.
* Identify and implement reimbursement optimization strategies while maintaining regulatory
compliance.
* Serve as the organization's reimbursement subject matter expert and trusted advisor to executive
leadership.

Cost Reporting
* Manage the preparation, review, and timely submission of Medicare, Medicaid, Tricare, and other
governmental cost reports.
* Ensure compliance with CMS regulations and applicable state reimbursement requirements.
* Coordinate the collection, validation, and reconciliation of reimbursement-related financial and
statistical data.
* Review cost report settlements, appeals, adjustments, and audit findings.
* Research, prepare, and support reimbursement appeals and position papers.

Government Reimbursement Programs
* Oversee reporting and compliance requirements related to:
* Medicare reimbursement
* Medicaid reimbursement
* Critical Access Hospital (CAH) status
* Medicare Dependent Hospital (MDH) programs
* Rural designations and wage index optimization
* Graduate Medical Education (GME)
* Disproportionate Share Hospital (DSH)
* Direct and Indirect Medical Education (DME/IME)
* Supplemental payment and upper payment limit programs
* Provider assessment and intergovernmental transfer programs

Audit & Regulatory Management
* Lead reimbursement-related audits conducted by Medicare Administrative Contractors (MACs), state
agencies, external auditors, and other regulatory bodies.
* Coordinate responses to reimbursement reviews and audit requests.
* Maintain supporting documentation and audit-ready processes.
* Monitor reimbursement risks and develop corrective action plans when needed.

Financial Analysis & Reporting
* Oversee reimbursement-related accounting activities, reconciliations, journal entries, and month-end
close processes.
* Analyze reimbursement reserves, settlements, receivables, and liabilities.
* Prepare financial analyses, forecasts, and reimbursement projections for leadership.
* Evaluate budget-to-actual variances and identify reimbursement-related revenue opportunities or
risks.
* Provide executive-level reporting on reimbursement performance and key financial trends.

Revenue Optimization
* Analyze reimbursement methodologies and payment models to identify revenue enhancement
opportunities.
* Evaluate the financial impact of service line growth, physician arrangements, and strategic initiatives.
* Support contract modeling and reimbursement analysis for payer negotiations.
* Collaborate with Revenue Cycle and Managed Care teams to improve reimbursement outcomes and
cash flow performance.

Graduate Medical Education (GME)
* Partner with GME leadership to support reimbursement and compliance initiatives.
* Evaluate resident FTE counts, cap management, affiliation agreements, and related reimbursement
implications.
* Coordinate reimbursement data requirements related to teaching programs and physician time studies.

Leadership & Staff Development
* Lead, mentor, and develop reimbursement professionals and analysts.
* Establish departmental goals, performance metrics, and development plans.
* Promote an environment of accountability, collaboration, innovation, and continuous improvement.
* Manage departmental workload, priorities, and resource allocation.

Strategic Collaboration
* Collaborate with Accounting, Finance, Revenue Cycle, Treasury, Budget, Legal, Compliance, Managed
Care, and Operational leaders.
* Support strategic planning, budgeting, forecasting, and organizational initiatives.
* Participate in special projects involving reimbursement, regulatory compliance, and healthcare finance transformation.

Additional Responsibilities
* Performs other duties as assigned.
* Complies with all policies and standards.
* For specific duties and responsibilities, refer to documentation provided by the department during orientation.
* Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.