Under the general supervision of the Director of Reimbursement, provides support to the Department by managing an effective, efficient, and regulatorily compliant workflow for preparing the Medicare cost report and Florida Hospital Uniform Reporting Standards (FHURS) annual submission, and all related government audits & reviews. The Reimbursement Manager is responsible for managing hospital reimbursement activities, supporting regulatory compliance, and ensuring accurate documentation of federal, state, and commercial payor reimbursement programs. Responsible for performing job duties in accordance with mission, vision, and values of Tampa General Hospital.
Essential Functions:- Monitor, interpret, and apply published federal and state regulatory changes related to Medicare, Medicaid, and other applicable payment methodologies, as well as private commercial payor requirements.
- Responsible for governmental filings for Tampa General Hospital assets including Community Hospitals, and affiliated partners.
- Provide leadership to reimbursement team to ensure alignment across the entity and system related to reimbursement programs, alternative payment systems, audit support, or related departmental initiatives.
- Manage Medicare, Medicaid, out-of-state Medicaid, PECOS, and related provider enrollment activities, including background screening, fingerprinting, revalidation, and ongoing maintenance.
- Oversee reimbursement support functions, including Medicaid remittance advice summaries, reserve updates, 340B eligibility, Medicare bad debts, crossover claims, contractual allowances, and related account review.
- Prepare, coordinate, and support responses to CMS proposed and final rules, including comment letters and regulatory impact analysis.
- Lead and support reimbursement-related audits and maintain appropriate documents for programs, including S-10, wage index, occupational mix, Medicare bad debt, GME, and other federal or state reimbursement reviews.
- Manage protested items, appeals, audit findings, and settlement-related matters in collaboration with internal stakeholders and external advisors.
- Conduct provider-based assessments and hospital licensure maintenance to support compliance with Medicare provider-based regulations.
- Administer hospital alternative payment systems, including Medicare organ acquisition cost-based reimbursement, Bundled Payments for Care Improvement Advanced, commercial bundled payment arrangements, and intergovernmental transfer accounting.
- Ensure appropriate work papers and supporting documentation are maintained for general ledger entries, balance sheet recordings, account reconciliations, and audit functions in accordance with departmental policies and procedures.
Qualifications- Bachelor's Degree in Finance or other related field.
- Minimum 5 (five) years hospital finance + reimbursement experience.
- An equivalent combination of education and years of experience.
Technical Knowledge, Skills, and Abilities:- Strong understanding of Medicare, Medicaid, GME, provider-based regulations, 340B eligibility, bad debt reimbursement, and alternative payment models.
- Excellent analytical, organizational, problem-solving, and documentation skills.
- Ability to manage multiple priorities, deadlines, audits, enrollments, renewals, and reporting requirements simultaneously.
- Strong written and verbal communication skills, including the ability to prepare regulatory responses, audit support, and executive-level summaries.
- Ability to collaborate effectively with Finance, Revenue Cycle, Compliance, Legal, Operations, external consultants, auditors, and government agencies.
- High attention to detail and commitment to accuracy, compliance, and process improvement.
