PARD In-Charge Auditor
- Hiring from
- United States
- Work type
- Remote
- Posted
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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%)
* 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%)
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 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 which is generally gained through 1 year of Medicare cost report auditing experience:
* 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:
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 discretionDemonstrated attention to detail
PREFERRED QUALIFICATIONS
* 1 1/2 to 2 years of Medicare cost report auditing experience
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.