Manager, Reimbursement

University Hospitals•Shaker Heights, OH

15h

About The Position

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.

Requirements

Bachelor's Degree in Accounting, Health Care Administration, or Finance (Required)
5+ years Healthcare accounting or consulting (Required)
3+ years Supervisory experience (Required)
Advanced knowledge of Medicare and Medicaid reimbursement methodologies. (Required proficiency)
Strong understanding of CMS regulations, cost reporting, reimbursement accounting, and payment reform initiatives. (Required proficiency)
Knowledge of physician and hospital reimbursement structures. (Required proficiency)
Experience with governmental and commercial payer reimbursement models. (Required proficiency)
Advanced financial modeling and analytical capabilities. (Required proficiency)
Strong understanding of GAAP and healthcare accounting principles. (Required proficiency)
Ability to translate complex reimbursement concepts into actionable business recommendations. (Required proficiency)
Experience utilizing large data sets to support reimbursement analyses and forecasting. (Required proficiency)
Advanced proficiency in Microsoft Excel, including complex modeling and data analysis. (Required proficiency)
Experience with ERP systems, reimbursement software, and healthcare financial reporting tools. (Required proficiency)
Experience leveraging automation, data analytics, and AI-enabled tools to improve reimbursement processes and reporting efficiency. (Required proficiency)
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.

Nice To Haves

Master's Degree (Preferred)
Certified Public Accountant (CPA) (Preferred)
Familiarity with business intelligence and visualization platforms such as Power BI, Tableau, SQL-based reporting tools, or related analytics solutions a plus.

Responsibilities

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.
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.
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, and Provider assessment and intergovernmental transfer programs.
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.
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.
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.
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.
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.
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.
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.