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   Current UPMC employees must apply in HR Direct

Manager, Reimbursement

  • Job ID: 440496040
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Corporate Finance
  • Department: Reimbursement
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $44.41 to $75.36 / hour

Description

We are in search of a highly motivated Manager, Reimbursement who is ready to take their career to the next level in a fast-growing companyThis role will work daylight hours Monday-Friday and will have flexible work arrangements. 

In conjunction with the Vice President and/or Director of Reimbursement, this position will manage the governmental and third party hospital reimbursement activities of all specifically designated System entities, including but not limited to hospitals located throughout Pennsylvania and in New York.  In conjunction with the Vice President and/or Director of Reimbursement, 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, disciplinary/corrective action, scheduling, departmental policies and procedure development and other areas of staff development.

UPMC has a Center for Engagement and Inclusion that is charged with executing leading-edge and next-generation diversity strategies to advance the organization’s diversity management capability and its national presence as a diversity leader. This includes having Employee Resource Groups, such as Women Inspiring Talent in Heath Care in Finance (WITH) or PRIDE Health, that support the implementation of our diversity strategy. 

Apply today!

Responsibilities:

  • In conjunction with the Vice President and/or Director of Reimbursement, 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, and occasionally travel to hospital sites and administrative offices as applicable for specified facilities.
  • 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 Vice President and/or Director of Reimbursement, manages the preparation of the graduate medical education resident affiliation agreement.
  • In conjunction with the Vice President and/or Director of Reimbursement, manages the preparation of the year-end CRA calculations and CRA model, ensuring that System providers are reporting proper and accurate data on a monthly basis.
  • In conjunction with the Vice President and/or Director of Reimbursement, oversee the staff's accumulation and analysis of data for identified revenue enhancement opportunities to optimize hospital reimbursement.
  • Research, evaluate, and 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 MA Modernization model including the Medicaid supplemental payments and the interaction with the Medicaid Disproportionate Share Upper Payment Limitation.
  • 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.
  • Manage and develop a staff of professionals and clerical personnel in conjunction with the Vice President and/or Director of Reimbursement.
  • Develop educational routes as well as train the staff in third party reimbursement principles and compliance regulations to enhance the staff's professional growth and knowledge of global healthcare, financial and industry issues.
  • Assist Vice President and/or Director Reimbursement with the re-openings for finalized cost reports if necessary to ensure compliance with the Medicare regulations and optimization of Medicare reimbursement.
  • In conjunction with the Vice President and/or Director of Reimbursement, researches and accumulates data for filing of formal appeals, exception requests to rates or payment methodologies to support the Hospital's position on governmental and third party regulations.
  • In conjunction with the Vice President and/or Director of Reimbursement, 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.
  • Implement, perform and manage financial analysis of new services, new programs and special projects as they arise.
  • Implement recruitment efforts and trains new personnel as well as evaluate personnel under incumbent's management including corrective/disciplinary action when necessary.
  • 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 Vice President and/or Director of Reimbursement, 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.


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UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct