Sr. Program Manager – Reimbursement- Acute

Responsibilities: Join a dynamic organization driven by our passion for healthcare. Organization is seeking talented individuals who are eager to contribute their expertise and pursue rewarding careers.As a leader in acute care and behavioral health, organization provides high-quality care to over 3 million patients annually, across our national network of facilities.The Corporate Reimbursement Department is hiring a Senior Program Manager - Reimbursement - Acute to manage the Medicare and Medicaid fee-for-service reimbursement functions for multiple assigned hospitals or other entities with complex reimbursement environments and that have a significant level of financial statement impact.This role will also ensure compliance with applicable federal and state reimbursement rules and regulations and optimizes Medicare and Medicaid reimbursement through development of strategic planning and on-going financial analysis. Key Responsibilities include: Complete Medicare and Medicaid cost report submissions for assigned hospitals or other entities and related desk review and audit activity (including wage index reviews or other Medicare/Medicaid reimbursement activity) for multiple facilities with complex reimbursement environmentsProvide independent on-going hospital reimbursement consulting services (e.g. compliance, billing, financial pro forma analysis) to corporate business office, regional finance and to hospital executive staff and other entities. Independently handle complex reimbursement projects and assignmentsOversee, coordinate and develop the reimbursement aspects of all acute care hospital Medicare alternate payment methodology activity with a focus on bundled payments, as applicableOversee, coordinate and develop the reimbursement aspects of all acute care hospital Medicare quality based payment methodology activity including but not limited to Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions, etc., as applicableProvide applicable Medicare and Medicaid contractual models, related reimbursement factors and other necessary data. Review these models for compliance and accuracyParticipate in the oversight, development and maintenance of Medicaid supplemental payment (UPL) and state Medicaid DSH programs for assigned facilitiesQualifications:Bachelor's degree with 10+ years' experience of Medicare cost reporting and concepts.Comprehensive knowledge of Medicare prospective payment systems including Inpatient Acute DRGs, Outpatient APCs, Rehabilitation CMGs and Psychiatric DRG'sThorough understanding of Medicare statutes, regulations and administrative rules and their related legislative and regulatory processes. Specific knowledge of Graduate Medicare Education (GME) and Indirect Medical Education (IME) reimbursementThorough understanding of Medicaid supplemental payment concepts including state directed payments and related provider tax assessmentsThorough understanding Medicare alternate payment concepts with a particular focus on Bundled PaymentsThorough understanding of Quality based Medicare reimbursement concepts (i.e. Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions, etc.)Intermediate-to-Advanced level knowledge of Microsoft ExcelFamiliarity with Mckesson G/L and Siemens InvisionProficiency in HFS cost report software (or its equivalent)

Created: 2025-06-08