Reference #: GUIDUS34477EXTERNALENUS10503
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 Lead 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, as well as interim rate review/reimbursement, and/or 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 and oversee daily workload of unit team.
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.
Lead Accountabilities (60%)
Coordinates with management by overseeing the unit's daily workload. Routinely uses independent judgment and discretion to make decisions for self and less experienced auditors with regard to additional time and procedures; identifies and raises errors to the attention of supervisor and/or provider and identifies and communicates actions to correct same. Prioritizes auditor work and ensures that audit work is completed on time. Recognizes data needs for self and other auditors; develops plan of work for less experienced auditors (10%)
Analyzes working papers and cost reports for errors. (10%)
Reviews workpapers of auditors for correctness, control and adherence to Generally Accepted Accounting Practices (GAAP), Generally Accepted Accounting Standards (GAAS) and Government Auditing Standards (GAS) as required. Examines and reviews workpapers upon completion of the audit to ensure compliance with CMS Uniform Desk Review (UDR), policy, or technical direction and reflects proper reference, clear and concise conclusion of the major audit categories and assembly of working papers into logical sequence. (10%)
Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal and State Government regulations for each class/type of provider within area of responsibility. (5%)
Develops technical competence and constructive work attitudes in self and less experienced auditors; strives to build an effective team and to develop the growth needs of individual members of his/her team. (10%)
Coordinates the assignments and subsequent development of auditors based on their training needs; explains work to be performed and principle or objective of procedure; provides accurate and constructive coaching, mentoring, and training of team members. Identifies training needs within the team and/or department. (5%)
Manages, implements and coordinates an internal quality control program in conjunction with t e Internal Quality Control (IQC) department and provides reasonable assurance that PARD has established, as well as is following, adequate policies, procedures, and is following applicable auditing standards. (5%)
Facilitates the development of Quality Management System (QMS) policies and procedures. (5%)
Auditor Accountabilities (40%)
Performs audit functions including those which are non-routine; keeps track of instructions for many projects simultaneously. Presents and defends adjustments and workpapers to provider with minimal consultation from manager. (10%)
Coordinates large audits and/ or diverse audits independently while seeking help on truly unusual or major items. (10%)
Uses professional communication techniques in own and auditor's work and in conclusions drawn from the work. (5%)
Establishes and maintains constructive provider relations by demonstrating a professional approach, expressing positive corporate image. Advises providers on Medicare policy questions and directs non-PARD area questions to responsible departments or personnel. (5%)
Conducts entrance and exit conferences and meetings away from office as needed. (5%)
Perform other duties as the manager may deem necessary (5%)
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 2.5 to 3 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 testing according to CMS standards
A review of DSH, inclusive of all relevant sample selection and 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 and approval of all work papers
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
Assistance to audit management in the assignment and monitoring of workload, as well as leading junior team members
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
