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
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.
