Appalachian Regional Healthcare

Reimbursement Manager

Job Locations US-KY-Lexington
Requisition ID
# of Openings
Business Professional
System Lexington
Posted Date
6 months ago(12/16/2022 8:21 AM)
Position Type
Regular Full-Time
Day Shift


The Reimbursement Manager is primarily responsible for ensuring the timely filing of third-party cost reports related to the Medicare, Medicaid/MCO, and Champus programs within established due dates.  This shall include both the annual required filing and any interim/mid-year reports for internal modeling and review. The Reimbursement Manager is also responsible for coordinating data gathering to meet requests from auditors and other third-parties, review of proposed audit adjustments, and preparation of any Management/Corporate response to audits/reviews, in conjunction with the Director and external consultants. This position will also be responsible for leading and supervising a team of analysts, and to ensure that the monthly close and balance sheet reconciliation processes [for settlement and related accounts] are properly executed and maintained.  The Reimbursement Manager will also be required to handle/oversee other functions as needed, including (but not limited to) proforma/cost analyses, managed care contracting, special projects, as well as research and analysis.

Special Instructions

This is a remote position.



The principal goal of the Corporation’s Reimbursement Team shall be timely execution of data gathering, preparation, review, and issuance of required third-party cost reports, with excellence and reliability.  Further, the Team shall have the goal of providing relevant financial, reimbursement, and operational data for optimal decision making.  Finally, the Reimbursement Team shall consistently add value to the Corporation through its efforts to enhance net revenue.



Duties include:

  1.  Manage all aspects of annual and interim cost reporting process, in conjunction and in consultation with Director.  This shall include establishing calendar/project plans, coordinating analyst staff assignments, ongoing collaboration with external consultants, review of workpapers, review of drafts, and other similar duties required to complete cost reports on time and with highest level of accuracy and completeness.
  2. Coordinate review and analysis of interim rate reviews, tentative settlements, desk review/pending settlement letters, NPRs, etc – within noted timeframes and deadlines to respond.  This shall include assignment of duties, high focus on audit adjustments, review of workpapers, and other similar duties.
  3. Seek to develop effective relationships with governmental auditors, such that the desk review and settlement process is augmented.
  4. Perform or supervise the completion of financial, cost, operational, and reimbursement proforma analyses to support the Project Planning Process.
  5. Supervise or complete other special reimbursement projects at the behest of the Director, CFO, or other senior leaders of the Corporation.
  6. Maintain and grow competency of reimbursement and health care finance knowledge through various means.  Effectively convey sophisticated reimbursement information to decision makers within the Corporation.  Provide educational presentations to various groups as needed.
  7. Oversee managed care contract review process, as well as analysis of new or amended payer contract proposals.
  8. Provide effective leadership, supervision, and oversight to a team of highly-performing analysts.
  9. Create/generate/facilitate reports from internal decision support system as needed and directed to provide clinical, operational, financial or other data for leaders and decision makers through the organization. 
  10. Assist CFO, Director of Finance, or other leaders in financial analysis and designated projects.  Provide leadership by contributing in a collaborative team of finance professionals.







 This candidate must have a Bachelor's degree in finance, accounting or business administration, or any comparable level of education, and experience preferably in a hospital setting.   Master’s degree or relevant certification [e.g. CPA] is a plus. 

Minimum Work



The successful candidate should have a minimum of 5 to 10 years of relevant experience in a healthcare finance setting, and should also have demonstrated expertise and knowledge in Medicare and Medicaid reimbursement regulations, including DSH, IME/GME, CAH, wage index and related topics.  Excellent computer skills [MS Excel/Office], and communication skills are a must. desirable.


Required Licenses/Certifications






Required Skills, Knowledge, and Abilities


·         Solid working knowledge of Medicare and Medicaid Regulations

·         Experience in preparation, review, and appeal of third-party cost reports

·         Knowledge of MAC/MCO/Agency operations; diplomatic skills and effective communications with auditors

·         Strong analytical and quantitative skills

·         Expertise in Excel and related computer applications

·         Excellent critical thinking skills.

·         Ability to multitask and prioritize assignments while producing high quality work in a demanding, fast-paced environment

·         Excellent verbal and written communication, teamwork, and relationship-building skills.

·         Effective presentation skills, along with comfort level in conversing and interacting with Corporate leadership

·         Excellent skills in managing workload timely and efficiently

·         Demonstrated leadership and ability to lead, supervise, and produce excellent results from team


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