Sys Manager Reimbursement-Government Programs Appeals

Where You’ll Work

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Job Summary and Responsibilities

As our System Manager, Reimbursement you will provide executive leadership, management, and coordination related to the government reimbursement services of CommonSpirit. This pivotal role ensures timely and accurate financial and governmental reporting, critically managing our reimbursement program according to relevant policy terms and conditions within the complex healthcare landscape.

Every day you will identify and implement innovative strategies, policies, procedures, and programs for all aspects of reimbursement management practices. You will proactively monitor and communicate federal and state regulatory proposals and changes regarding healthcare reimbursement, providing effective solutions to address evolving reimbursement service needs. Additionally, you will oversee, evaluate, and continuously improve the productivity and performance of our dedicated reimbursement staff members.

To be successful in this role, you will need proven expertise in healthcare finance, government reimbursement methodologies, and regulatory compliance. We are seeking a visionary leader with exceptional analytical skills, a deep understanding of Medicare and Medicaid reimbursement, and a demonstrated ability to develop and lead high-performing teams in a large healthcare system.

• Reimbursement Management: Manages the organization's reimbursement activities, ensuring timely and accurate financial reporting, and implements related strategies, policies, and procedures.
• Regulatory & Policy Expertise: Monitors and communicates federal and state regulatory changes in healthcare reimbursement, providing effective solutions to address associated issues.
• Team Leadership: Manages the productivity and performance of reimbursement staff members.
• Reporting & Audits: Possesses knowledge of Medicare/Medicaid cost reporting, actively reviews and assists with hospital cost reporting, and prepares for third-party audits.
• Financial Analysis & Accounting: Applies financial analysis tools and accounting methods to read, interpret, and maintain accurate financial statements and reports, including monthly net revenue reviews.
• State & Regulatory Compliance: Understands state supplemental programs (including projections and bookings), works with State Hospital Associations, and ensures compliance with federal, state, and local healthcare regulations.

Job Requirements

Required 

• Bachelor's Degree in Accounting, Finance, Business Administration or related field.
• Minimum of five (5) years of intensive experience with Medicare and Medicaid reimbursement
• two (2) years of net revenue experience
• minimum of two (2) years of management experience.