USA Health · 10 hours ago
Reimbursement Manager- USA Health
Mobile, AL
Full-time
Onsite
Senior Level
5+ years expUSA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. The Reimbursement Manager is responsible for overseeing all reimbursement activities for USA hospitals, ensuring compliance with federal and state laws while developing relationships with third-party payers and managing various reimbursement-related tasks.
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Responsibilities
Responsible for all reimbursement activities for USA hospitals in accordance with federal and state laws or regulations
Will assist the Assistant Reimbursement Director in preparation aspects of interim and annual Medicare and Medicaid, BCBS and Champus Cost Reports and related activities, including work-paper preparation, document preparation, filings, audit appeals, adjustments and re-openings for hospitals and the home office
Will learn and maintain expertise with the reimbursement software
Accepts increasing responsibilities in working with external contacts: CMS personnel, the fiscal intermediary personnel, and external auditors to provide necessary information to support cost reports
Will develop relationships with third party payer personnel, intermediaries, and governmental personnel concerning reimbursement activities
Conducts self in a manner that promotes a positive image amongst all customers (internal and external) by exercising sound and ethical business practices as related to employees, patients, external contacts, vendors, and the general public, ensuring that the quality of products and service is of the highest possible level appropriate to the situation
Works actively to develop and maintain competency in the changes to reimbursement filing and reporting requirements for CMS, BCBS, Champus, CHGME and other payers
Develops awareness of changes and developments of new and proposed health care laws and regulations through online review of CMS and other payer documentation
Develops as resource to Assistant Reimbursement Director and Director as well as other department managers and Senior Management on reimbursement-related matters
Assists the Reimbursement Director and Assistant Reimbursement Director with the preparation and filing of HCFA 855 other certification forms as required
Assists the Assistant Reimbursement Director with the preparation of CHGME reports, this includes the initial and reconciliation application for CHGME Grant Funding and the Annual Performance Report
Will learn and maintain competency for the online electronic HRSA Handbook
Responsible for learning the New Innovations software and functions as a resource to Reimbursement Department and the Resident Training Departments in the proper reporting of the Resident’s time
Will also learn the IRIS function of the New Innovations and provide support in the development of data for the Cost Reports
Will assist the department Director in the creation of the Hospital Affiliation Agreements, Cap Sharing Agreements, submissions to Medicare and the Fiscal Intermediary and the review/preparation of Non-Hospital Affiliation Agreements
Will learn and become proficient in the Medicare Resident Limits, its laws and regulations
Develop and continually reviews department processes to improve the functions through effective use of information systems and coordination of efforts with other staff, including patient accounting, the Health System and University Finance Departments
Will learn the System's reimbursement activities as well as other hospital activities impacting reimbursement
Notify the Assistant Reimbursement Director, Reimbursement Director and if necessary other management of any acts, transaction, or circumstances which are not fully in compliance with federal, state, or local laws or regulations
Aid and assist both the Reimbursement Director and Assistant Reimbursement Director to record and maintain contractual adjustments, bad debts and charity allowances as they affect the financial statements of the operating divisions
Review, verify and reconcile balance sheet reserves, and Medicare, Medicaid, Blue Cross and Commercial or other Governmental settlement accounts
Communicates as required with personnel from University, Hospitals, College of Medicine, third parties, regulatory agencies, or others in connection with work assignments, information gathering and reporting
Assists the Assistant Reimbursement Director and Reimbursement Director with periodic net revenue forecasts, contractual adjustment, bad debts, budgets, other recurring and non-recurring reimbursement analysis, and special projects
Will develop department data from Ad Hoc Reporting as necessary
Participates in in-services and educational offerings to learn new skills and for continued development
Assist in training personnel to assure they are competent to carry out their essential functions and that competency skills are completed annually
If necessary, will assist Assistant Reimbursement Director and Reimbursement Director in monitoring work performance of staff
Assists the Assistant Reimbursement Director in completing staff evaluations in timely manner according to policy
If necessary will assist Assistant Reimbursement Director in developing a plan of action for employees who are below satisfactory in their evaluation and completes re-evaluation in the appropriate time frame
Participates in the strategic planning activities for the department and institution
Assists to develop strategic plan for the department that supports the institution's overall plan
Translates the department or institution strategic plan to staff, ensuring support of the plan, and modifying the plan in response to changing internal and external factors
Assumes accountability for current standards established by professions, regulatory and governmental agencies
Determines, translates and implements relevant standards and promotes department compliance
Maintains standards of practice consistent with generally accepted accounting practice
Adheres to current Infection Control and Safety Standards
Facilitates cooperative and collaborative relationships among disciplines/departments to assure effective delivery of services to support quality patient care
Encourages and participates in planning and program development to facilitate the effective delivery of services that support quality patient care
Communicates and uses appropriate customer relation skills with physicians, patients, families, outside parties, and healthcare team in person and via telephone
Develops and maintains a performance improvement program for the department utilizing the ICARE methodology
Regular and prompt attendance; Ability to work schedule as defined and overtime as required; Related duties as required
Qualification
Required
Bachelor's degree in accounting, finance, business administration, or directly related field from an accredited institution as approved and accepted by the University of South Alabama
Five years of progressively responsible accounting or financial analysis experience
Hospital and/or reimbursement experience is highly preferred
Directly related professional experience may substitute on a year-for-year basis for the required education
Company
USA Health
USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Candice Powers, MBA, CRCR, CRCA
Chief Revenue Officer (CRO)
Sherry Fryman
Chief Nursing Officer
Recent News
Charleston Business
2025-06-27
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