Reimbursement Manager Jobs in Springfield, MA (NOW HIRING)

The Sr. Financial Analyst, Revenue and Reimbursement is responsible for monthly, quarterly, and annual revenue analysis and reporting across all hospital and specialty group departments for both Connecticut Children's Medical Center (CCMC) and Connecticut Children's Specialty Group (CCSG). The role manages State and Federal reporting requirements, directs support for DSH and other audits, and ensures revenue is recognized in accordance with contracted terms through the month-end close process. The Sr. Financial Analyst analyzes payer, physician, and patient payment information against applicable contract terms, government regulations, and internal policies, and supports annual revenue budgeting and forecasting. Work is performed under general supervision in close collaboration with Financial Planning and Financial Analysts across the department.

Education and/or Experience Required:

• Education: Bachelor's degree from accredited college or university.
• Experience:  5 years' experience in Healthcare Revenue Cycle or Healthcare Finance departments.

License and/or Certification Required:

• N/A

Knowledge, Skills and Abilities:

Knowledge:

• ICD-10, CPT coding, and medical terminology.
• Insurance regulations and reimbursement policies, including managed care, Medicare, and Medicaid.
• Generally accepted revenue recognition standards specific to the hospital industry.
• State and Federal reporting requirements applicable to healthcare finance.
• CMS cost report methodology and DSH program requirements.
• Healthcare financial management principles, including budgeting and forecasting.
• Microsoft Word and Excel; experience with healthcare financial systems preferred.

Skills:

• Strong analytical and financial modeling skills with a high degree of accuracy and attention to detail.
• Proficiency in data analysis, variance reporting, and revenue reconciliation.
• Excellent written and verbal communication skills, including the ability to present financial data clearly to varied audiences.
• Strong organizational and project management skills with the ability to manage multiple deadlines simultaneously.
• Ability to develop and maintain effective working relationships across departments.

Abilities:

• Ability to interpret and apply complex regulatory requirements, payer contracts, and internal policies.
• Ability to work independently under general supervision while exercising sound judgment.
• Ability to identify problems, analyze root causes, and recommend practical solutions.
• Ability to adapt to changing priorities in a dynamic healthcare environment.
• Commitment to maintaining strict confidentiality of all financial and patient-related information.
   

Revenue Analysis & Reporting-40%

• Prepares monthly, quarterly, and annual revenue analysis and reporting across all hospital and specialty group departments.
• Ensures revenue recognized for CCMC and CCSG through the month-end close process is in accordance with contracted terms for services rendered.
• Demonstrates technical knowledge of generally accepted revenue recognition standards specific to the hospital industry.
• Analyzes incoming payment information and communications from payers, physicians, and patients in conjunction with applicable contract terms, reimbursement schedules, government regulations, and internal policies.
• Identifies and investigates revenue variances; prepares written analysis and presents findings to leadership as needed.
• Monitors payer contract performance and identifies opportunities for revenue optimization or recovery.
• Develops productive relationships across Finance departments, including Revenue Cycle, Financial Operations, Financial Reporting, and Contract Management.

Budgeting & Forecasting-20%

• Supports the annual revenue budget process, including preparation of supporting schedules and documentation.
• Provides regular updates to revenue forecasts, incorporating changes in payer mix, utilization trends, contract terms, and regulatory developments.
• Supports new business initiatives with revenue expectations and scenario modeling.

Reimbursement & Compliance-10%

• Assists with establishing physician fee schedules by CPT codes for each cost center and department.
• Supports reimbursement analysis and regulatory compliance monitoring.
• Ensures all actions are consistent with applicable government regulations, contractual terms, and internal policies and procedures.
• Maintains current knowledge of changes to CMS regulations, state Medicaid policy, and managed care reimbursement methodologies.

State & Federal Reporting Requirements-20%

• Completes the following requirements in a timely manner:
• CMS Annual Cost Report.
• Connecticut Hospital Association Surveys.
• Children's Hospital Association Surveys.
• DSH Survey.
• OHS Annual Filing and OHS 12 Month Filing.
• CHGME Grant:
  • Initial Application.
  • FTE Documentation.
  • Reconciliation Application.
  • Annual Report Facilitation.

Audit Support-10%

• Directs the preparation of support materials related to DSH audits and other audit requirements as needed.
• Coordinates with internal departments and external auditors to ensure timely and accurate responses to audit inquiries.

Performs Other Duties as Assigned.