Manager, Reimbursement

University Hospitals -
Shaker Heights, OH

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Job Details

$114,358 - $178,859 a year
1 day ago

Qualifications

Management
Automation software
Business consulting
Supervising experience
Bachelor's degree
Health insurance knowledge
Accounting and finance experience
Financial projection model development
Healthcare financial management
Financial forecasting analysis
AI-driven automation
Data analysis software
Financial process automation

Full Job Description

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.

Education Qualifications

Bachelor's Degree in Accounting, Health Care Administration, or Finance (Required)
Master's Degree (Preferred)

Experience Qualifications

5+ years Healthcare accounting or consulting (Required)
3+ years Supervisory experience (Required)

Skills and Abilities

Healthcare Reimbursement Expertise - Advanced knowledge of Medicare and Medicaid reimbursement

methodologies. Strong understanding of CMS regulations, cost reporting, reimbursement accounting,
and payment reform initiatives. Knowledge of physician and hospital reimbursement structures.
Experience with governmental and commercial payer reimbursement models. (Required proficiency)

Financial & Analytics Skills - Advanced financial modeling and analytical capabilities. Strong

understanding of GAAP and healthcare accounting principles. Ability to translate complex
reimbursement concepts into actionable business recommendations. Experience utilizing large data sets
to support reimbursement analyses and forecasting. (Required proficiency)

Technology & Systems - Advanced proficiency in Microsoft Excel, including complex modeling and data

analysis. Experience with ERP systems, reimbursement software, and healthcare financial reporting
tools. Familiarity with business intelligence and visualization platforms such as Power BI, Tableau, SQLbased
reporting tools, or related analytics solutions a plus. Experience leveraging automation, data
analytics, and AI-enabled tools to improve reimbursement processes and reporting efficiency. (Required
proficiency)

Leadership Competencies - Strategic thinking and business acumen. Strong project management and

organizational skills. Excellent written, verbal, and executive presentation skills. Proven ability to lead
cross-functional initiatives and influence stakeholders. Ability to manage competing priorities in a
dynamic healthcare environment.

Licenses and Certifications

Certified Public Accountant (CPA) (Preferred)

Physical Demands

Standing - Occasionally
Walking - Occasionally
Sitting - Constantly
Lifting - Rarely (up to 20 lbs)
Carrying - Rarely (up to 20 lbs)
Pushing - Rarely (up to 20 lbs)
Pulling - Rarely (up to 20 lbs)
Climbing - Rarely (up to 20 lbs)
Balancing - Rarely
Stooping - Rarely
Kneeling - Rarely
Crouching - Rarely
Crawling - Rarely
Reaching - Rarely
Handling - Occasionally
Grasping - Occasionally
Feeling - Rarely
Talking - Constantly
Hearing - Constantly
Repetitive Motions - Frequently
Eye/Hand/Foot Coordination - Frequently

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