Job Requirements

The Reimbursement Manager reports to the Director of Finance and is the key contact for third party payor matters at Heywood Healthcare. The Reimbursement Manager is a dynamic leader who challenges conventional wisdom and has professional, respectful, and supportive relationships with key stakeholders, staff, consultants, auditors, and vendors alike. The Reimbursement Manager will support the CARE Values of the organization, and the goal of providing outstanding customer service to those we are privileged to serve. They engage their team members to help solve today’s challenges. The Reimbursement Manager is responsible for supporting the Finance Director in the following areas: third party payor filings, reviewing charge master, review of payor contracts and understanding financial impact of those contracts, annual revenue and reimbursement budgeting. The Reimbursement Manager is responsible for managing the Reimbursement Department in day to day operations and is an integral to the Director of Finance’s team in meeting the operational challenges in today’s healthcare environment.

Minimum Education

• BS or BA with major in Accounting is highly recommended

Minimum Work Experience

• 5-7 years in Hospital Accounting
• 4-6 years experience in third party reimbursement

Required Skills

• Must be versatile, having the ability to complete most accounting functions.
• Must be knowledgeable of Revenue Cycle and impact on reimbursement and governmental filings.
• Must have a high level of telephone and face to face verbal and listening skills in order to communicate effectively with co-workers, supervisors, managers and outside agencies.

Functional Demands

Physical Requirements:

Exerts up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Frequently reaches (extending hands and arms in any direction), and handles (seizing, holding, grasping, turning, or working with hands).

Essential Functions

• Keeps up to date on current laws and regulations pertaining to Accounting and Reimbursement issues and is aware of their effect on reimbursement.
• Gathers and maintains all information necessary for third party reporting relating to reimbursement issues (including the Medicare 2552, DHCFP-403, and UCC reports) and complies with all governmental regulations pertaining to the content and accuracy of reports filed.
• Informs the Finance Director on the status of on-going projects, and any other issues/irregularities related to job duties so that he/she is aware of significant or unusual problems.
• Notifies the Finance Director of any recurring problems after attempts to resolve.
• Communicates with various other internal/external customers as necessary, regarding reimbursement issues.
• Calculates monthly contractual adjustments and reserves.
• Coordinates the third party portion of the annual financial audit and ensures that all schedules and contractual calculations are completed within the set audit time frame.
• Communicates with third party auditors and gathers all information necessary for them to perform annual audit of our reports. Notifies the Controller of any significant issues.
• Performs net revenue forecasting and budget projections.
• Reviews major changes to the Charge master with the Director of Patient Financial Services to ensure optimum reimbursement.
• Performs third party analytical work in support of financial decision making.
• Monitors payors for reimbursement performance and contract payment compliance, and reports on their performance, identifying contract variances.
• Maintains a database of payors contract terms and payment schedules so as to provide accurate assessments of net revenue estimates at the procedural level, as needed.
• Ensures that all revenues have been recorded in the proper month and provides explanation of variance

Statement of Other Duties:

This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described.