Salary: $66,400.00 - $119,500.00 Annually
Location : Richland County, SC
Job Type: FTE - Full-Time
Job Number: 189981
Agency: Department of Health and Human Services
Division: Reimbursements.
Opening Date: 08/12/2026
Closing Date: 8/18/2026 11:59 PM Eastern
Class Code:: AN23
Position Number::Normal Work Schedule:: Monday - Friday (8:30 - 5:00)
Pay Grade: GEN11
Agency Specific Application Procedures:: Failure to provide detailed and complete information may result in your application not being referred.
Veteran Preference Statement: South Carolina is making our Veterans a priority for employment in state agencies and institutions.
Job Responsibilities*This position is a re-post. Previous applicants do not need to re-apply.*This position is located in
Reimbursements, Richland County. This is an in-office role and not a telecommute or remote position.
Are you the One? We are looking for an
Audits Manager I (Reimbursements Manager - Nursing Home & Federally Qualifying Health Centers), who willmanage the team implementing Medicaid reimbursement policies and rate-setting methodologies for Nursing Homes (NHs) and Federally Qualifying Health Centers (FQHCs). This position ensures provider payments are accurate, compliant with State and Federal regulations, and aligned with program goals. This position also ensures the accuracy and completeness of staff analyses and deliverables through regular review and guidance. Conducts desk reviews and performs rate setting activities for NHs and FQHCs to ensure alignment with Federal regulations and State Medicaid policy. Performs financial analyses of proposed reimbursement methodologies and rate structures for new and existing Medicaid services.
- Manage the efforts to request, collect, track, and store digital copies of Medicaid Cost Reports for NHs. Interpret and apply legislative regulations found in the State Plan to calculate specific and statewide Nursing Home Rates along with Swing Bed and Administrative Day Rates. Prepare NH Rates for submission to CMS and ensure approved rates are submitted for input to SCDHHS' claims-handling application, Medicaid Management Information System (MMIS). Review team's calculation of Nursing Home Settlements for retro-rate adjustments based on Audits or Consent Orders. Review NHs annual submissions of Professional Liability Claims support for compliance and calculations of amounts to reimburse NHs per the State Plan. Ensure accurate communication of Requests, Payments, Rate Changes, and Reimbursement Methodology changes to NHs. Maintain audit-ready documentation for all data sources, calculations, methodologies, approvals, and rate-setting decisions.
- Use Excel Macros and software applications to extract relevant data from both Medicare and Medicaid Cost Reports. Run and review Statistical Analysis System (SAS) Queries that extract claims data from MMIS' reporting layer and ensure a proper understanding of the output. Prepare Upper Payment Limit Demonstration for Nursing Homes for CMS. Periodic review and reconciliation of Reimbursement Payment Logs for audit purposes. Respond to FOIA (Freedom of Information Act) Requests for NHs. Ensure accurate communication of Requests, and Reimbursement Methodology changes to NHs. Maintain audit-ready documentation for all data sources, calculations, methodologies, and approvals.
- Description:
Manage the efforts to request, collect, track, and store digital copies of both Medicare and Medicaid Cost Reports for FQHCs. Use Excel Macros and software applications to extract relevant data from both Medicare and Medicaid Cost Reports. Interpret and apply legislative regulations found in the State Plan to determine Rates for new FQHCs and ensure these rates are submitted properly for input to SCDHHS' claims-handling system, MMIS. Review FQHCs Change in Scope submissions to confirm compliance with state and federal regulations. Calculate rate adjustments for FQHCs based on properly submitted Change in Scope requests. Quarterly review of staff's determinations, calculations, and data pulled to support supplemental wrap payments that ensure FQHCs receive legislated payments for certain Fee-for-Service Dental services or certain services paid by Managed Care Organizations. Periodic review and reconciliation of Reimbursement Payment Logs for audit purposes. Run and review SAS Queries that extract claims data from MMIS' reporting layer and ensure a proper understanding of the output. Respond to FOIA Requests for FQHCs. Ensure accurate communication of Requests, Payments, Rate Changes, and Reimbursement Methodology changes to FQHCs. Maintain audit-ready documentation for all data sources, calculations, methodologies, approvals, and rate-setting decisions. - Review staff's monthly preparation of NH Expenditure and Utilization Reports prior to submission to the Director and Chief of the Bureau. Complete research to include running of SAS queries to verify and confirm completeness and accuracy based on the identification of anomalies by Management or internal and external inquiries received by the Bureau.
- Performs fundamental supervisory and leadership functions in accordance with Department policies and procedures, best practices and Federal and State rules and regulations, especially with regard to Equal Employment Opportunity Commission (EEOC) standards. Maintains an effective organizational team and motivates diverse staff to accomplish mission critical operations and objectives. Promotes workforce engagement and a safe, professional, and productive work environment for all employees.
- Perform additional duties as assigned within the specified timeframe and according to the directions made available at the time of the assignment.
- Ensure all rates that the bureau sets are updated according to state and federal regulations and requirements and have been approved by executive leadership. Coordinate the publishing of approved rates with the Office of Communications. Review and monitor published rates for completeness and accuracy.
The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:- Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
- 15 days annual (vacation) leave per year.
- 15 days sick leave per year.
- 13 paid holidays.
- State Retirement Plan and Deferred Compensation Programs.
Minimum and Additional Requirements A bachelor's degree in accounting, business administration, finance, insurance, or a related field and experience in professional level accounting, auditing, or financial management.
An equivalent combination of education and experience may be accepted with prior State Human Resources approval.
Preferred: At least two (2) years managing accountants and/or auditors. Experience with Medicare or Medicaid reimbursement principles and cost report preparation. Knowledge of Medicaid and Federal/State regulations, rate setting methodologies, and accounting and financial management practices.
Additional Requirements:- Overtime and/or weekend work with Deputy approval
- Sitting or standing for long periods of time.
- Lifting requirements: 25 lbs.
- In-office role.
Preferred Qualifications- Knowledge of standard software applications (spreadsheets, macros, databases, reporting systems, etc.).
- Knowledge of data collection, reporting standards, and documentation requirements.
- Ability to exercise sound judgment and make data-based decisions in addition to working effectively with provider organizations and partner agencies.
Additional Comments Please complete the State application to include all current and previous work history and education.
A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.
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The responses you provide to these Supplemental Questions will be used in combination with your application to determine whether you meet the minimum qualification requirements. Please, thoroughly complete the Education and Work Experience sections of your application and the Supplemental Questions. Failure to provide detailed and complete information will result in your application being rejected. Any misrepresentation or omissions will result in your disqualification from employment and/or termination. You may not submit resumes in lieu of filling out the application or answering the Supplemental Questions. I acknowledge that I have read, understand, and agree with the above.
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Please indicate your expected salary, if offered this position.
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Do you have a bachelor's degree in accounting, business administration, finance, insurance or a related field?
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Do you have experience in professional-level accounting, auditing or financial management?
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Do you wish to claim Veteran Preference? If yes, you must submit a copy of your DD214 Form with your job application in order to qualify and claim this preference.
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How did you hear about this career opportunity?
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