Reimbursement Specialist - Healthcare jobs in Ohio

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.  

The Manager Healthcare Reimbursement will lead a team of cost reporting analysts on a wide range of Medicare and Medicaid hospital cost report and third-party reimbursement issues. The manager serves as a lead and technical expert on reimbursement and regulatory rules. They support and review hospital Medicare and Medicaid cost report filings, audits, settlements, and rate reviews. The manager reviews and understands regulatory rules and changes as they impact hospitals and affect reimbursement. Includes responsibility for reviewing governmental budgeting, regulatory changes, month-end close, and audit.

The ideal caregiver is someone who has:

• Successful experience with Medicare and Medicaid Reimbursement leading a wide range of hospital 3rd party reimbursement initiatives.

• Accounting and/or Finance background.

• Microsoft Excel experience (intermediate to advanced).

• Strong project management skills.

• High-level management and leadership skills.

• Can be agile in a fast-paced environment.

This is a rewarding opportunity that offers growth-oriented projects, mentorship, support, and resources. You will experience great exposure to both the institute and department leadership and have numerous opportunities for career growth.

At Cleveland Clinic, we know what matters most. That's why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you'll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you'll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Responsibilities:

Manages, reviews, and supports completion and filing of annual Medicare and Medicaid cost reports.

Manages reviews of cost report tentative settlements, rate reviews, final settlements, and audit adjustments.​

Review of regulatory rules and changes to determine hospital financial impacts surrounding Organ Acquisition, IME/DGME/DSH, etc.

Models and presents operational scenarios and related reimbursement impacts.

Provides expertise in modeling governmental reimbursement for long range forecast and budget.

Responsible for Medicare and Medicaid cost report audits, desk reviews, wage index audits, S-10 audits, and state DSH audits.

Serves as lead subject matter expert on third party reimbursement and cost report/reimbursement regulations.

Oversees, manages, and reviews third-party balance sheet reserves and reconciliations.

Federal and state governmental reporting duties.

Other duties as assigned.

Education:

Bachelor's degree in Accounting, Finance or equivalent.

Advanced degree preferred.

Complexity of Work:

Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.

Must be able to work in a stressful environment and take appropriate action.

Work Experience:

A minimum of 3 or more years of demonstrated financial management experience in health care.

Prior experience with Medicare and Medicaid highly preferred.

Physical Requirements:

Typical physical demands include a high degree of dexterity to produce materials on a PC, normal or corrected vision, extensive sitting and frequent walking, occasional lifting or carrying 5 to 15 pounds.

Personal Protective Equipment:

Follows standard precautions using personal protective equipment as required.

Pay Range

Minimum hourly: $40.48

Maximum hourly: $61.74

The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic's benefits package, which includes among other benefits, healthcare/dental/vision and retirement.