Reimbursement Manager

Inova Health System; Woodburn (VA); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare provider is seeking a dedicated Reimbursement Manager to oversee reimbursement processes and ensure compliance with regulations. This full-time position offers remote eligibility for candidates in several states. The ideal candidate will have seven years of reimbursement experience in healthcare, including management experience, and a Bachelor's Degree in Business Administration or Accounting. Responsibilities include directing reimbursement studies and collaborating with Medicare auditors.

Qualifications

• Seven years of reimbursement experience in a healthcare setting, including at least two years in management.
• Experience in end-to-end Medicare cost reporting.
• Direct experience with Medicare auditors.

Responsibilities

• Direct the preparation of reimbursement studies as needed by senior management.
• Research regulations related to the implementation of new programs.
• Prepare Home Office work papers for submission to Medicare.
• Oversee assigned department to ensure effective performance.

Skills

Reimbursement experience

Managerial skills

Regulatory knowledge

Audit interaction

Education

Bachelor's Degree in Business Administration or Accounting

Job description

Overview

Inova Health is looking for a dedicated Reimbursement Manager to join the team. This is a full-time day shift position, Monday–Friday, 8:00 a.m.–5:00 p.m., Remote.

Key Responsibilities

• Direct the preparation of reimbursement studies as needed by senior management.
• Research regulations related to the implementation of new programs, services, and ventures.
• Research regulations for developing techniques for maximizing reimbursement.
• Prepare and coordinate the necessary journal entries and explanations for monthly processing.
• Direct the evaluation of interim payments from third-party payers for accuracy and adequate cash flow.
• Coordinate with Information Systems regarding the production of reports for cost reporting/analysis purposes.
• Review Generally Accepted Accounting Principles and auditing standards as they apply to the reimbursement area.
• Develop and conduct reimbursement seminars for the staff of Health Information Systems (HIS) operating units.
• Prepare work papers for the Home Office cost statement and defend them when audited.
• Take ownership of Graduate Medical Education (GME) and Indirect Graduate Medical Education (IGME) reimbursement. Stay abreast of Centers for Medicare & Medicaid Services regulatory changes that impact GME/IGME reimbursement.
• Work with the GME Office to maintain documentation on the GME Program to support cost reports.
• Complete the IRIS report for submission to Medicare annually.
• Prepare Home Office work papers and Home Office cost statements for submission to Medicare and Medicaid.
• Review Medicare/Medicaid settlements for accuracy and impact on reimbursement for all HIS entities.
• Take ownership of the appeal of cost reports. Prepare position papers for filing with the Provider Reimbursement Review Board.
• Work with the GME Office to maintain the necessary documentation to count residents for GME/IGME reimbursement.
• Stay abreast of GME/IGME regulations. Review filed cost reports for accuracy and reasonableness while performing analysis of trends as appropriate.
• Review final settled cost reports to determine if the next steps are appropriate.
• Prepare position papers for Medicare/Medicaid appeals including responses to the Medicare Fiscal Intermediary.
• Document and defend adequacy of reserves for all open Medicare/Medicaid cost reports.
• Review and maintain processes for completion of required documentation to support the ability to claim accurate reimbursement in wage index, DSH, and bad debts.
• Maintain knowledge of changing regulations through reading regulations, newsletters, and continuing education workshops.
• Oversee assigned department or functional area to ensure it is performing effectively, which may include hiring and training team members, creating and implementing business strategies, managing performance, and delegating tasks.
• May perform additional duties as assigned.

Minimum Qualifications

• Experience: Seven years of reimbursement experience in a healthcare setting, including at least two years in a management position.
• Education: Bachelor’s Degree in Business Administration or Accounting.

Preferred Qualifications

• End-to-End Medicare cost reporting: Expertise including preparation, amendments, reopenings, settlements, and audit/appeals interaction.
• Amendments & Appeals: Identifies amendment opportunities; manages appeal timelines; documents and defends reserves on open reports; prepares the monthly journal entries for the cost report reserves.
• Audits & Interaction: Direct experience collaborating with Medicare auditors, including issue resolution, audit responses, and negotiating findings.
• Vendor Coordination: Manages external reimbursement vendors (scope definition, data exchanges, and QA of workpapers/deliverables).
• Provider Enrollment: Hands-on with Medicare provider enrollment, modifications, revalidations, and coordination to secure timely effective dates aligned to cost reporting would be a plus.

Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV