PARD Auditor - Novitas Solutions

GuideWell Source • Remote, FL

4d • Remote

About The Position

The Provider Audit and Reimbursement Auditor (PARD) may perform desk review/audit work and interim rate reviews. The role analyzes cost reports and provider statistical and reimbursement report information to determine accurate, timely tentative settlements of bad debt payments and other pass-through costs. It also performs limited and full desk reviews of cost reports for providers receiving Medicare reimbursement and assists senior staff with hospital audits.

This opportunity is open to remote work in approved states: AL, AR, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, and WY. Specific counties and cities may require further approval. In Florida and Pennsylvania, in-office and hybrid work may also be available.

Applicants may be required by the Federal Government and CMS to have lived in the United States for at least three of the last five years. Selected applicants must clear pre-employment background investigation, drug screening, and identity-proofing requirements. Further screening, including fingerprinting, may be required for government system access, and continued employment is contingent on meeting applicable government requirements. Applicants must have access to an eligible current, unrestricted identity document.

Requirements

• Bachelor’s degree, or a combination of education and experience in auditing, accounting, analytics, finance, or a similar discipline in lieu of a degree.
• Demonstrated oral, written, and interpersonal communication skills.
• Computer skills, including knowledge of Microsoft Office applications such as Excel, Word, Outlook, and PowerPoint.

Responsibilities

• Analyze cost reports and provider statistical and reimbursement report (PS&R) information to determine accurate and timely tentative settlements for Skilled Nursing Facilities (SNFs), End Stage Renal Disease (ESRD) providers, and Federally Qualified Health Centers (FQHCs)/Rural Health Clinics (RHCs), including bad debt payments and other pass-through costs.
• Analyze cost reports and accompanying bad debt logs to update pass-through payment amounts and determine lump-sum adjustments for interim rate accuracy.
• Perform limited and full desk reviews of cost reports for SNFs, ESRDs, FQHCs/RHCs, and hospitals receiving Medicare reimbursement.
• Generate and customize required internal and external correspondence and checklists to support desk reviews and document their completion.
• Coordinate with the Senior and/or In-Charge auditor in performing hospital audits; complete post-audit follow-up with provider representatives and prepare the final cost report package.
• Work on special projects that may include duplicate interns and residents (IRIS) data, cost report information transmission (HCRIS), wage index submissions, STAR updates and provider tracking, continuing education and training (CET), HFS cost report software, SNF pass-through logs, and PS&R backup.
• Assist management with department administration, including creating and maintaining electronic and hard-copy provider cost report files and participating in continuous improvement projects.
• Attend entrance and exit conferences and advise healthcare providers on Medicare policy questions as needed.
• Perform other duties as assigned by the supervisor.

Benefits

• Medical, dental, vision, life, and supplemental insurance plans effective the first day of the month following 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.

What This Job Offers

• Job Type: Full-time