Are you interested in joining a team of experienced healthcare experts and have
the ability to shape and transform the healthcare delivery system? At our family
of companies, everything we do is to help improve the lives of the nearly 12
million Medicare beneficiaries we serve and 700,000 health care providers who
care for them. It is our goal to help create a better health experience for all
consumers. Join our winning culture and help transform Medicare for the millions
of people who rely on its services.
Benefits info:
Medical, dental, vision, life and supplemental insurance plans effective the
first day of the month following date of hire
Short- and long-term disability benefits
401(k) plan with company match and immediate vesting
Free telehealth benefits
Free gym memberships
Employee Incentive Plan Employee Assistance Program
Rewards and Recognition Programs Paid Time Off and Paid Sick Leave
SUMMARY STATEMENT
The Provider Audit and Reimbursement Senior Auditor utilizes advanced knowledge
of Medicare laws, regulations, instructions from the Centers for Medicare and
Medicaid Services (CMS), and provider policies to perform desk reviews and
audits of the annual Medicare cost reports, interim rate review/reimbursement,
and settlement acceptance/finalization for all provider types including complex
and organ transplant hospitals, as both a preparer and reviewer of work product
based on established performance goals. The position will mentor and train
Auditors and In-Charge Auditors.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each
essential duty satisfactorily. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions. This list of
essential job functions is not exhaustive and may be supplemented as necessary.
Audit Accountabilities (65%)
Analyzes the cost report and computes complex rate reviews on large and medium
size facilities for accurate intern payments. (10%)
Analyzes the cost report and completes the calculation of cost-to-charge
ratios (CCRs) and provider payment information, ensuring accuracy. (10%)
Analyzes the cost report by comparing the prior year to the current year and
completing the desk review, coordinates with Lead on field audits and is in
charge of field audits of small, medium and large sized providers and Medicare
cost report appeals. (10%)
Performs supervisory reviews of desk reviews performed by other members of the
audit staff by providing relevant review points that facilitate the coaching,
mentoring, and training of less tenured staff. Ensures that provider desk
reviews, cost report appeals and field audits are completed in accordance with
CMS regulations and Government Auditing Standards. (10%)
Establishes or maintains constructive provider relations by demonstrating a
professional approach, expressing positive corporate image and assisting
provider in problem areas. Advises healthcare providers on Medicare policy
questions. (10%)
Establishes the timeliness and scheduling of audits and desk reviews to ensure
compliance with requirements for CMS metrics and internal production goals.
(10%)
Accountable for special projects relating to complex payment methodologies.
This involves research, project planning, training of staff and timely
implementation of CMS requirements. (5%)
Development/Mentoring Accountabilities (30%)
Assigns and develops auditors based on their training needs; explains work to
be performed and principle or objective of procedure; provides accurate,
constructive feedback; determines future training needs. Identifies training
needs within the team and department and provides training to staff on
reimbursement principles, the process of completing simple to complicated rate
reviews, and for reviewing simple to complex rates at the first review level.
(10%)
Serves as a mentor in the department. (10%) Ensures development of quality
product that meets or exceeds CMS expectations. (10%)
Other (5%)
Attends entrance and exit conferences and advises healthcare providers on
Medicare policy questions as needed. This includes attending and completing the
required number of hours of Continuing Education Training (CET). (5%)
Performs other duties as the supervisor may, from time to time, deem necessary.
REQUIRED QUALIFICATIONS
Bachelors' degree or a combination of education and experience in disciplines
such as auditing, accounting, analytics, finance or similar experience in lieu
of a degree
In addition to having a thorough understanding of the Medicare cost report,
including the step-down method, the candidate must possess the required work
experience to independently perform the duties of the position.
To demonstrate the necessary experience, the candidate must have performed the
following tasks at a sufficiently successful level to show understanding of the
work, judgment, and the ability to perform these tasks independent of
supervision, which is generally gained through 2 years of Medicare cost report
auditing experience:
A Uniform Desk Review (UDR) and an audit for a large or complex hospital, as
the in-charge auditor
A review of Medicare Bad Debts, inclusive of all relevant sample selection and
relevant testing according to CMS standards
A review of DSH, inclusive of all relevant sample selection and relevant
testing according to CMS standards A review of IME/GME, inclusive of reviewing
rotation schedules, bed count and all relevant testing according to CMS
standards
A review and appropriate approval of an audit's scope
A supervisory review of certain provider types (may vary by team)
Sample testing, transferring of testing to the audit adjustment report, and
explaining the adjustments to a provider with the achievement of understanding
by the provider
Additionally:
The auditor must display leadership skills by being integrally involved in
junior auditor formal training or assisting on special projects, or have been a
Subject Matter Expert (SME)
The auditor must be able to prepare workpapers according to CMS standards The
auditor must have a good working knowledge of all applicable software
applications
The auditor must be able to serve as an effective mentor for less experienced
staff
The auditor must demonstrate engagement, commitment to departmental success, and
professionalism by completing their work within prescribed deadlines, taking
ownership of their work and setting an example for more junior auditors and
staff by consistently and reliably working the time necessary to properly
complete their duties, timely attending meetings, providing adequate notice to
management and co-workers when unexpected issues arise, and ensuring work is
properly covered in the auditor's absence
Demonstrated oral and written communications skills
Demonstrated ability to exercise independent judgement and
discretionDemonstrated attention to detail
PREFERRED QUALIFICATIONS
2 to 3 years of Medicare cost report auditing experienceDemonstrated work
experience to independently perform:
A review of Nursing & Allied Health Education (NAHE), inclusive of calculating
the additional add-on payment and all relevant testing
A review of Organ Acquisition costs, inclusive of all relevant testing
review of Organ Acquisition costs, inclusive of all relevant testing
MBA,CPA
Qualifications
The Federal Government and the Centers for Medicare & Medicaid Services (CMS)
may require applicants to have lived in the United States for a minimum of three
(3) years out of the last five (5) years to be employed with the Company. These
years of residence do not have to be consecutive.
Background Investigation: If you are selected for this position, you must
undergo a pre-employment Background Investigation, Drug Screen, and Identity
Proofing documentation must be cleared prior to hire. Most positions are subject
to additional Identity Proofing, Fingerprinting and additional Background
Investigation screening conducted by the Federal Government to be granted
Enterprise User Administration (EUA) system logical access after you begin your
employment. Your continued employment is contingent upon the outcome of the
complete additional screening criteria required for the position which must find
that you meet the applicable government customer's requirements (e.g., suitable
for access to CMS information and information systems), as well as any
additional investigation which may be required throughout your employment. If
you are found not suitable, your employment may be subject to corrective action,
up to and including immediate termination of employment.
Identity Documentation: You must have access to a current and unrestricted REAL
ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent
Residency Documents. Note: Employment Authorization Cards (EAD) are not a
substitute for Visas or U.S. Permanent Resident Cards.
"We are an Equal Opportunity/Protected Veteran/Disabled Employer."
This opportunity is open to remote work in the following approved states: AL,
AR, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI,
WY. Specific counties and cities within these states may require further
approval. In FL and PA in-office and hybrid work may also be available.