PARD Lead Auditor - Novitas

GuideWell Source • Remote, OH

2d • Remote

About The Position

The Provider Audit and Reimbursement Lead (PARD Lead Auditor) uses advanced knowledge of Medicare laws, regulations, CMS instructions, and provider policies to prepare and review desk reviews and audits of annual Medicare cost reports. The role also performs interim rate reviews and reimbursement activities, and settlement acceptance and finalization for all provider types, including complex and organ transplant hospitals. The position mentors and trains Auditors and In-Charge Auditors and oversees the unit team's daily workload.

The role combines lead responsibilities with hands-on auditing. It coordinates and prioritizes unit work, reviews audit workpapers and cost reports for accuracy and compliance with applicable auditing standards and CMS requirements, and supports staff development and internal quality control. The auditor also independently conducts complex audits, presents and defends adjustments and workpapers to providers, and maintains professional provider relationships.

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. Selected candidates must clear pre-employment background investigation, drug screening, and identity proofing. Additional federal screening may be required for access to CMS systems; continued employment is contingent on satisfying applicable government customer requirements. Applicants must have access to an eligible current and 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.
• Thorough understanding of the Medicare cost report, including the step-down method.
• Generally 2.5 to 3 years of Medicare cost report auditing experience demonstrating the ability to perform the role's duties independently.
• Experience serving as in-charge auditor for a Uniform Desk Review and an audit of a large or complex hospital.
• Experience reviewing Medicare Bad Debts, including relevant sample selection and testing according to CMS standards.
• Experience reviewing DSH, including relevant sample selection and testing according to CMS standards.
• Experience reviewing IME/GME, including rotation schedules, bed counts, and relevant CMS-standard testing.
• Experience reviewing and appropriately approving an audit's scope.
• Experience performing supervisory review and approval of workpapers, sample testing, transferring testing to the audit adjustment report, and explaining adjustments to providers until understood.
• Experience assisting audit management with assigning and monitoring workload and leading junior team members.
• Leadership experience through involvement in formal junior auditor training, special projects, or service as a Subject Matter Expert.
• Ability to prepare workpapers according to CMS standards.
• Good working knowledge of applicable software applications.
• Ability to mentor less experienced staff effectively.
• Professionalism, engagement, and commitment to departmental success, including completing work by deadlines, taking ownership, setting a positive example, attending meetings on time, communicating unexpected issues promptly, and ensuring work coverage during absences.
• Demonstrated oral and written communication skills.
• Demonstrated ability to exercise independent judgment and discretion.
• Demonstrated attention to detail.
• May be required to have lived in the United States for at least three of the last five years, subject to federal government and CMS requirements.
• Must undergo required pre-employment background investigation, drug screen, and identity proofing; additional federal screening may apply.
• 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.

Nice To Haves

• Three to four years of Medicare cost report auditing experience.
• Experience reviewing Nursing & Allied Health Education (NAHE), including calculating the additional add-on payment and performing relevant testing.
• Experience reviewing Organ Acquisition costs, including relevant testing.

Responsibilities

• Oversee the unit's daily workload, prioritize auditor assignments, make independent decisions about additional time and procedures, identify errors, and ensure audit work is completed on time.
• Identify data needs and develop work plans for less experienced auditors.
• Analyze working papers and cost reports for errors.
• Review auditors' workpapers for correctness, control, and adherence to GAAP, GAAS, Government Auditing Standards, CMS Uniform Desk Review requirements, policy, and technical direction.
• Review workpapers upon audit completion to ensure appropriate references, clear conclusions, and logical assembly.
• Review, evaluate, and approve tentative cost settlement disbursements in compliance with applicable federal and state regulations.
• Develop technical competence and constructive work attitudes in self and less experienced auditors, and foster team effectiveness and individual growth.
• Coordinate auditor assignments and development based on training needs; explain work and procedures; coach, mentor, and train team members; identify training needs.
• Manage, implement, and coordinate an internal quality control program with the IQC department and support compliance with policies, procedures, and auditing standards.
• Facilitate development of Quality Management System policies and procedures.
• Perform non-routine audit functions and manage instructions for multiple projects simultaneously.
• Present and defend audit adjustments and workpapers to providers with minimal management consultation.
• Independently coordinate large or diverse audits and seek assistance for unusual or major items.
• Use professional communication techniques in audit work and conclusions.
• Maintain constructive provider relations, advise providers on Medicare policy questions, and direct non-PARD questions to responsible departments or personnel.
• Conduct entrance and exit conferences and meetings away from the office as needed.
• Perform other duties as assigned by the manager.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior