Reimbursement Integrity Manager (FT), Corporate Reimbursement Department

190003SC Requisition #





Develops and maintains an effective system-wide process for maintaining reimbursement integrity and works collaboratively with D-H leaders, including affiliates, to maximize reimbursement opportunities while ensuring compliance.


Utilizing a comprehensive understanding of coding guidelines, reimbursement methodologies, compliance issues, including a working knowledge of Medicare & Medicaid payment rules and regulations, provides analysis and education to the organization with regard to issues pertaining to reimbursement and compliance risks.




Key Responsibilities:


  1. Establishes and manages an effective system of interdepartmental communications and processes as it pertains to reimbursement, compliance, regulatory and billing issues.

  2. Effectively interprets, communicates and presents to applicable leadership changes in the Federal Register, Medicare and Fiscal intermediary transmittals, bulletins, and memoranda which may impact D-H’s established processes related to reimbursement, compliance and billing.

  3. Supports the filing and audits of Meaningful Use reports.

  4. Coordinates and leads special projects and/or multidisciplinary work groups for the purpose of identifying and resolving issues pertaining to billing, reimbursement, revenue leakage, and compliance issues.

  5. Audits and identifies coding and billing issues as they pertain to reimbursement optimization and compliance risks. 

  6. Develop, review and maintain policies and procedures for reimbursement integrity. Acts as a resource to D-H and affiliates

  7. Analyzes changes in Medicare and Medicaid fee schedules and MS-DRG coding changes.

  8. Provides support in the calculation of net revenues for the monthly financial statements, projections, the annual budget, product line profitability, new service lines/procedures and other ad hoc analysis.

  9. Will serve as the Coordinator for the Contract Management Team and the RevGen Workgroup.

  10. In conjunction with Compliance and Audit Services (CAS), manages the responses to Office of Inspector General (OIG) Audits, Recovery Audit Contractor (RAC) Audits, BISC Audits, third-party audits, etc.

  11. Provides timely and effective communication for requests from external organizations such as the New Hampshire Hospital Association, consultant firms, law firms, etc.

  12. Performs other duties as required or assigned.



Minimum Qualifications:

  • Bachelor’s degree in finance or accounting (preferred) with a minimum of 5 years of experience in healthcare reimbursement required.

  • Managerial experience preferred.

  • Background in healthcare coding desired.

  • Knowledge of Medicare and Medicaid payer rules, billing guidelines, and regulations for Hospital and Professional services.

  • Understanding of ICD-10, CPT and HCPHC coding, DRG and APC payment methodologies, and UB04 and 1500 billing rules.

  • Highly effective verbal/written communications, strong interpersonal skills, computer and organization skills are essential. 

  • Customer oriented, self-motivated and capable of working independently.

  • Must be able to function as a team member and work under time pressures with deadlines.


Required Licensure/Certification Skills:

  • None

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