Manager, Reimbursement

SUMMARY: Under the general direction of the Director of Reimbursement, the Reimbursement Manager will be responsible for a number of complex assignments. This position is expected to function independently with a minimum amount of oversight and will be expected to develop and implement processes and programs intended to assist the Alameda Health System in optimizing supplemental reimbursement; data collection and analysis; CA Public Hospital waiver and GPP performance; appeals and cost reporting. Manage and oversee Reimbursement day to day operations and staff. Perform related duties as required.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1. Accurately prepares and assembles all financial and statistical reports required for cost reimbursement and reports to government and third party agencies consistent with current regulations and contract terms.

2. Analyzes and models financial and statistical data used in third party reimbursement related to hospital reimbursement or final settlements. Manages staff in assisting the Divisions of Patient Accounting in maintenance of contract module and modeling reimbursement changes. Develops and maintains reimbursement accounting, modeling systems, budgets, statistics collections, monitoring reports and variance reporting.

3. Ensures full reconciliation of supplemental accounts receivable to the general ledger.

4. Immediately notifies the Chief Financial Officer, Vice President of Finance, or Controller of any unusual activities or changes in policy related to supplemental reimbursements.

5. Keeps abreast of changes related to state and national initiatives and impending legislative changes through participation in local and statewide associations, such as, the California Association of Public Hospitals. Oversee the valuation of third party settlements, review cost report preparation and monitor audits and appeals.

6. Plans, coordinates and manages periodic reimbursement related audits by external and other auditors; participates with reimbursement consultant(s) in the identification of appropriate appeals issues and annual cost report reviews.

7. Provides and oversees reimbursement training for financial, billing and accounting staff.

8. Responsible for managing the operations of the Reimbursement Department including the development of budget and operational targets, and managing employees.

MINIMUM QUALIFICATIONS:

Education: Bachelor’s degree in business, accounting, economics or related field. Master’ preferred.

Experience: Five years financial experience with minimum two years of direct work experience. Work experience in public health system or hospital preferred.

Preferred Licenses/Certification: Any HFMA or related professional organization certificates are desirable.