Mgr, Reimbursement & Net Rev - Finance - Full Time (Hybrid)

Summary

Under the direction of the Corporate Financial Controller, the Manager of Reimbursement is responsible for the oversight, review, and integrity of the monthly Accounts Receivable (AR) valuation and net patient service revenue for all hospital entities within the integrated healthcare system. This role provides leadership and supervision to the Hospital Reimbursement Analyst and serves as a key partner to Financial Operations in analyzing and interpreting trends and variances in net patient revenue.

Responsibilities include oversight of the estimated payment process, third-party liability (TPL) reconciliations, and accounting related to Medicare and Medicaid cost report filings and settlements. The Manager also manages key third-party relationships, including reimbursement-related SaaS vendors and cost report preparation partners, ensuring service quality, data integrity, and alignment with organizational requirements. Additionally, this role evaluates and monitors third-party payer contracts to ensure accurate net revenue estimation and supports other net revenue and receivable analyses and special projects as requested.

Experience

• Five to eight years of progressive experience in net revenue accounting, reimbursement analytics, and/or cost reporting required.
• Demonstrated analytical and critical thinking skills with the ability to manage complex data and adapt to changing priorities.
• Supervisory or lead experience required.
• Familiarity with Oracle, Epic, and Kodiak RCA (formerly Crowe) strongly preferred.
• Advanced proficiency in Excel and strong working knowledge of Word required.

Education

• Bachelor’s degree with a preferred emphasis on accounting, finance, economics, or related field of study from an accredited four-year institution.  A Master’s degree in Business Administration or related field and/or CPA is preferred.

Essential Functions

• People Leadership & Oversight
  • Directly supervises the Hospital Reimbursement Analyst, providing technical guidance, performance management, and professional development.
  • Establishes priorities, ensures quality and timeliness of deliverables, and promotes consistency.
• Net Revenue Recognition SaaS Platform Management
  • Serves as the business owner and subject matter expert for the net revenue recognition SaaS platform, overseeing monthly close activities, methodology governance, data integrity, audit support, and vendor management to ensure accurate and compliant net revenue and AR valuation reporting (see specific Key Responsibilities listed below).
• AR Valuation & Net Revenue Analytics
  • Provide oversight and review of the monthly AR valuation and related third-party receivables and payables for hospital entities.
  • Support CFOs and Controller with analytics through analysis of trends, risks, and variances in net patient service revenue and AR reserves.
  • Analyze and project the financial impact of operational changes, payer mix shifts, and reimbursement changes to support reserve adequacy for management, audit and forecast purposes.
• Cost Reporting & Estimated Payments
  • Manage partnership with third-party in the preparation and review of supporting schedules for all Medicare and Medicaid cost report submissions.
  • Support accounting for cost report settlements, estimated payments, and related accruals in coordination with Corporate Accounting.
  • Partner with internal and external auditors during cost report audits and desk reviews.
• Third-Party Liability (TPL) & Contract Monitoring
  • Partner with third party professionals to research and interpret Medicare/Medicaid regulations and determine impact on entities within the Organization, become familiar with federal and state reimbursement methodologies and ensure that the Organization maintains compliance and become familiar with State and Federal reimbursement laws and regulations and third-party payor contracts and will ensure accuracy of reimbursement.
  • Partner with Revenue Cycle partners to proactively develop policies and procedures to ensure that all legitimate reimbursement is captured
  • Coordinate the preparation of Medicare/Medicaid cost reports for the System with third party professionals.
  • Oversee third-party liability reconciliations, ensuring accurate identification, valuation, and accounting of TPL payables and receivables.
  • Maintain awareness of contractual and regulatory changes affecting third-party reimbursement for acute care hospitals, freestanding ambulatory surgery centers, multi-specialty physician group practices, Home Health / Hospice services and Residency Programs.
  • Evaluate and monitor third-party payer contracts to ensure accurate net revenue estimation and consistency with system reimbursement models.
• Cross-Functional Collaboration & Advisory
  • Partner with Financial Operations, Revenue Cycle, Accounting, and Compliance to ensure alignment of reimbursement assumptions and financial reporting.
  • Provide reimbursement expertise to leadership in support of audits, regulatory inquiries, and ad hoc financial analyses.

Other Duties

1. Participates in committees, projects as assigned.
2. Assists with continuing education of department and operational personnel.
3. Performs other duties as assigned.

#LI-RS1