Reference #: GUIDUS33912EXTERNALENUS10503
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 In-Charge Auditor utilizes 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 for health care providers including small and mid-sized hospitals; evaluates, researches, and assesses health care worker wages for appropriateness of billings; and arrives at correct annual settlements of Medicare reimbursements while protecting the interests of all providers, CMS and the taxpayers. The In-Charge Auditor is both a creator and reviewer of work product.
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.
Performs provider interim rate reviews, tentative settlements, cost report appeals, and full and limited desk reviews requiring increased skill and increasing complexity including ability to audit small to medium-sized hospitals. Coordinates with the Senior and/or Lead auditor on field audits and serves as an in- charge auditor of field audits of small to medium- sized providers. (20%)
Analyzes the cost report and establishes appropriate inpatient and outpatient interim reimbursement rates and other payment factors by analyzing pertinent financial and statistical data and applying applicable regulations and reimbursement principles. This is done to ensure that interim payments to large Prospective Payment System (PPS) hospitals and other providers with high dollars at risk approximate final Medicare liability. (20%)
Completes most assigned audit/reimbursement functions with a minimum of supervision or assistance. Recognizes errors and makes judgments about materiality and the need for additional time and audit steps; self-checks for errors. (20%)
Establishes the timing and scheduling of audits within the allotted time budgeted. Prepares audits by analyzing the prior review compared to the as submitted cost report and develops a comprehensive request to the provider for information. (20%)
Defends his/her adjustments to the provider after collaboration with manager or Lead. (10%)
Attends entrance and exit conferences and advises healthcare providers on Medicare policy questions, as needed. (5%)
Performs other duties as the supervisor may deem necessary, including attending and completing 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'/Master's degree with a concentration/major in Accounting or Finance. Bachelor's/Master's degree in other fields can qualify if the candidate has 15 or more credit hours in specific Accounting o Finance classes.
In addition to having a basic understanding of the Medicare cost report, the candidate must possess the required work experience to perform the following with a high degree of independence:
A Uniform Desk Review (UDR) for a moderately complex hospital
An audit of a small to medium size facility
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 testing according to CMS standards
Sample testing, transferring of testing to the audit adjustment report, and explaining the adjustments to the provider
Additionally:
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 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 discretion
Demonstrated attention to detail
PREFERRED QUALIFICATIONS
MBA
CPA
This opportunity is open to remote work in the following approved states: AL, AK, FL, GA, ID, IN, IO, KS, KY, 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, PA, TX and WI, in-office and hybrid work may also be available.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."We are an Equal Opportunity Employer/Protected Veteran/Disabled"Novitas Solutions, Inc. is an Equal Opportunity Employer - Protected Veteran/Disabled
