Reimbursement Manager

Applications are submitted online until the position is filled and/or the posting is closed. After reviewing this job announcement, please click on the link at the bottom of the page to apply online. A resume is required with the application. Further instructions on submission of documents are available in the online application. A resume may not be substituted for an application.Minimum Requirements: An Associates degree in Business Administration, Accounting, Financial Management, or a related field AND three (3) years of experience in medical reimbursement in a hospital, long term care, or other health related facility to include one (1) year of supervisory experience. An equivalent combination of education, experience, and training is acceptable. It is the policy of Allegheny County that in order to receive a final offer of employment, candidates must successfully pass a background check, which includes verification of Allegheny County Real Estate Tax status.Position Summary: Incumbent supervises and participates in the processing of reimbursements from Part B Medicare and coinsurances for ancillary charges to DERMC. Work is performed in accordance with Federal, state and local standards, guidelines, and regulations that govern long-term care facilities under the direction of the Revenue Controller.Overview: Duties: Supervises the work of subordinate staff, through assignment of work, establishment of priorities, approval of leave requests, and the completion of performance appraisals.Applies payments daily from Medicare and coinsurances using Solution One & SOS programs.Determines residents' insurance coverage status and qualifications for either Medicare Part B billing or non Medicare B billing and inputs into appropriate programs.Tracks unpaid and rejected claims.Organizes billing documentation for enteral and wound care claims.Inputs billing information and documentation.Prepares requests for missing or additional documentation for wound care from nursing representatives.Receives weekly wound care reports, supply orders, and doctor's orders.Prepares and submits claims for wound care to Medicare Part B and obtains acknowledgement reports of accepted claims.Receives enteral monthly report from Resident Service Managers and Dietitians and makes any corrections or requests any needed documentation.Prints insurance, census, and ICD9 code reports for Resident Services Managers and Dietitians.Inputs Part B enteral and projected enteral changes for following months and actual enteral changes on non-B residents.Compiles and sends to Medicare reviews for under and unpaid claims.Provides in-service information to nursing and dietary staff on the documentation required to support reimbursement for charges related to ancillary services.Performs related tasks and other duties as assigned by the Revenue Controller. Knowledge, Skills, and Abilities Knowledge of: Principles and practices of supervision.Medicare and Medicaid regulations regarding reimbursements. Skill in: Microsoft Office Suite Ability to: Operate a personal computer.Relate to and work with ill, disabled, elderly, and emotionally upset people within a long-term care facility.Communicate effectively with vendors, employees, applicants, residents, family members, visitors, government agencies, and general public. Read, write, and understand written and oral instructions. Residency: Allegheny County within 1 year. Veterans' Preference: Will be awarded to eligible candidates. AN EQUAL OPPORTUNITY EMPLOYER - M/F/V/D

Created: 2026-04-02