At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic unfolds. Visit upmc.com/vaccinesupport to learn more about how you can help.

Our recruiters will continue to fill positions throughout this time, but interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Manager, Reimbursement--Harrisburg

  • Job ID: 662234226
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Pinnacle Health Support Services
  • Department: Revenue Integrity
  • Location: 409 South Second Street, Harrisburg PA 17104
  • Union Position: No
  • Salary Range: $40.84 to $61.28 / hour

Description

Purpose:


In conjunction with the Reimbursement Director, this position will manage the governmental and third party hospital reimbursement activities of all specifically designated System entities, including but not limited to UPMC Pinnacle, UPMC Memorial, UPMC Carlisle, UPMC Lititz, UPMC Hanover, and Pennsylvania Psychiatric Institute. In conjuction with the Reimbursement Director, the Reimbursement Manager position will manage, control and administer all personnel management functions for the Reimbursement Department, including but not limited to, interviewing, recruiting, hiring, training, performance appraisals, scheduling, upholding departmental policies and procedure development as well as other areas of staff development.

Responsibilities:

  • In conjunction with the Reimbursement Director, manages and validates the preparation of third party interim rates, including the distribution of those rates to the applicable internal departments.
  • Research, evaluate, interpret and enforce all government and third-party payer contracts.
  • Manage the organization and maintenance of work papers and files in a concise and orderly manner.
  • Develop and or manage the timely preparation, accuracy, and integrity of year-end third party cost reports for those facilities serviced.
  • In conjunction with the Reimbursement Director, manages the staffs' preparation of the resident counts necessary for the preparation of the resident affiliation agreement.
  • In conjunction with the Reimbursement Director, manages the preparation of the Cost Report Accrual model, ensuring that System providers are reporting proper and accurate data on a monthly basis.
  • In conjunction with the Reimbursement Director, oversee the staff's accumulation and analysis of data for identified revenue enhancement opportunities to optimize hospital reimbursement.
  • In conjunction with the Reimbursement Director, research, evaluate, interpret proposed and final Medicare regulations, including special regulatory provisions to ensure staff's compliance with Medicare regulations and optimization of Medicare reimbursement and any new Medicaid reimbursement methodologies including but not limited to the Medicaid Modernization model including the Medicaid supplemental payments and the interaction with the Medicaid Disproportionate Share Upper Payment Limitation.
  • In conjunction with the Reimbursement Director, Reimbursement Manager is responsible for delegating the workload to reimbursement personnel staff and is responsible for training and instruction needed to complete their assignments.
  • Manage day-to-day routine and non-routine departmental reimbursement activities.
  • In conjunction with the Reimbursement Director, the Reimbursement Manager is responsible for controlling and enforcing the timely and accurate submission, accumulation and maintenance of all supporting information relating to the cost reports, which includes reports from individuals in various departments throughout the UPMC organization and outside sources.
  • Manage the activities of all third-party auditors including, but not limited to, audit exit conferences, including reviews, researching and recommending alternatives to third party audit adjustments.
  • In conjunction with the Reimbursement Director, research, evaluate, and interpret all government and third-party payer regulations, educating staff members on all applicable Medicare and Medicaid regulatory changes.

 

Qualifications

  • Bachelor's degree in accounting/finance or related business field with eight years of Medicare/Medicaid reimbursement experience working with a health care provider and/or a multi-health care system and/or Medicare/Medicaid intermediary required.
  • Master's degree, MBA, and/or CPA preferred.
  • Specialized Training Requirements
    • Extensive knowledge of third party regulations and reimbursement practices and health care accounting.
    • Supervisory experience is needed in a reimbursement or hospital finance setting.
    • Must be able to interact with peers and subordinates, and all organizational levels of management.
    • Must have superior interpersonal, written, and oral communication skills.
    • Requires minimal supervision.
    • Advance proficiency in the use of personal computers.
    • Must possess excellent planning, analytical and creative thinking skills, and also possess good decision making skills.
    • Also must be able to handle confidential material and develop and motivate department personnel, fostering an environment of dignity and respect.


Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days.
 

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct