PARD Lead Auditor - Novitas

GuideWell Source•Remote, FL

2d•Remote

About The Position

The 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 review and reimbursement work and/or settlement acceptance and finalization for all provider types, including complex and organ transplant hospitals. The Lead Auditor mentors and trains Auditors and In-Charge Auditors and oversees the unit’s daily workload. The position coordinates and prioritizes audit work, reviews cost reports and workpapers for accuracy and compliance with applicable standards and CMS requirements, and reviews and approves tentative cost settlements. It also supports team development, coordinates auditor assignments and training, and helps manage internal quality control and Quality Management System policies and procedures. As an auditor, the role performs routine and non-routine audit work, coordinates large or diverse audits, presents and defends adjustments to providers, communicates audit conclusions professionally, maintains constructive provider relations, and conducts entrance and exit conferences as needed. The role may also perform other duties assigned by the manager. This opportunity is open to remote work in specified approved states. In Florida and Pennsylvania, in-office and hybrid work may also be available. Employment is subject to required pre-employment and government background screening, drug screening, and identity proofing. Applicants must have access to an accepted current and unrestricted identity document. The Federal Government and CMS may require a minimum of three years of U.S. residence in the last five years for employment.

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 sufficient to independently perform the role’s duties.
Experience conducting a Uniform Desk Review and auditing a large or complex hospital as the in-charge auditor.
Experience reviewing Medicare Bad Debts, including sample selection and testing according to CMS standards.
Experience reviewing DSH, including sample selection and testing according to CMS standards.
Experience reviewing IME/GME, including rotation schedules, bed count, and relevant testing according to CMS standards.
Experience reviewing and appropriately approving an audit’s scope.
Experience performing supervisory review and approval of all workpapers.
Experience with sample testing, transferring testing to the audit adjustment report, and explaining adjustments to providers so they understand them.
Experience assisting audit management with workload assignment and monitoring and leading junior team members.
Demonstrated leadership through involvement in junior auditor formal training, assistance on 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.
Demonstrated engagement, commitment to departmental success, and professionalism, including completing work by prescribed deadlines, taking ownership, reliably working the time needed to complete duties, attending meetings on time, communicating unexpected issues promptly, and ensuring work is covered during absences.
Demonstrated oral and written communication skills.
Demonstrated ability to exercise independent judgment and discretion.
Demonstrated attention to detail.
Must complete applicable pre-employment background investigation, drug screening, and identity proofing before hire; additional government screening, fingerprinting, and identity proofing may be required for system access and continued employment.
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

3 to 4 years of Medicare cost report auditing experience.
Experience independently reviewing Nursing & Allied Health Education (NAHE), including calculating the additional add-on payment and relevant testing.
Experience independently reviewing Organ Acquisition costs, including relevant testing.

Responsibilities

Oversee the unit’s daily workload, prioritize auditor work, and ensure audit work is completed on time.
Use independent judgment to determine when additional time or procedures are needed; identify errors and communicate corrective actions to supervisors and/or providers.
Recognize data needs and develop plans of work for less experienced auditors.
Analyze working papers and cost reports for errors.
Review auditors’ workpapers for correctness, control, and adherence to GAAP, GAAS, GAS, CMS Uniform Desk Review requirements, policy, and technical direction.
Review and approve tentative cost settlement disbursements in accordance with applicable federal and state regulations.
Develop technical competence and constructive work attitudes in less experienced auditors and support individual and team development.
Coordinate auditor assignments based on training needs and provide coaching, mentoring, and training.
Identify training needs within the team or department.
Manage and coordinate an internal quality control program with the IQC department and provide reasonable assurance that appropriate policies and procedures are established and followed.
Facilitate development of Quality Management System policies and procedures.
Perform routine and non-routine audit functions and track instructions across multiple projects.
Present and defend audit adjustments and workpapers to providers with minimal manager consultation.
Independently coordinate large or diverse audits, seeking help 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 questions outside PARD to the appropriate department 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 insurance
Dental insurance
Vision insurance
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
Paid Sick Leave