Manager, Reimbursement

University Hospitals Pain Management; Shaker Heights (OH); On-site; USD 120,000 - 180,000; Full time

Job summary

University Hospitals Pain Management in Shaker Heights, OH is seeking a Manager, Reimbursement to lead strategic oversight of third-party reimbursement for the health system. You will direct Medicare, Medicaid, Tricare, and other programs while partnering with Finance and Revenue Cycle to maximize reimbursement opportunities and ensure regulatory compliance.

You will oversee cost reporting, government programs, audits, and financial analytics, mentor staff, and provide executive-level reporting

Responsibilities

• Direct and oversee all reimbursement functions in compliance with federal, state, and payer regulations.
• Monitor Medicare, Medicaid, Tricare, 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.
• Coordinate responses to reimbursement reviews and audit requests; maintain audit-ready documentation.
• Oversee reimbursement-related accounting activities, reconciliations, and month-end close processes.
• Analyze reimbursement reserves, settlements, receivables, and liabilities; provide financial analyses to leadership.
• Collaborate with Revenue Cycle and Managed Care teams to improve reimbursement outcomes and cash flow.

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.