PARD Sr Auditor - Novitas Solutions

GuideWell Source • Remote, FL

4d • Remote

About The Position

The Provider Audit and Reimbursement Senior Auditor applies advanced knowledge of Medicare laws, regulations, CMS instructions, and provider policies to conduct desk reviews and audits of annual Medicare cost reports, interim rate reviews and reimbursements, and settlement acceptance and finalization for all provider types, including complex and organ transplant hospitals. The position prepares and reviews work product in line with established performance goals and mentors and trains Auditors and In-Charge Auditors.

The Senior Auditor performs and reviews audits and desk reviews, supports provider relations, schedules work to meet CMS metrics and internal production goals, and handles special projects involving complex payment methodologies. The role also develops staff through training, feedback, mentoring, and quality oversight, and participates in provider conferences and continuing education.

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. Employment is contingent on required pre-employment screening and applicable government suitability and identity-proofing requirements.

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.
• Experience generally gained through two years of Medicare cost report auditing, with demonstrated ability to independently perform the duties of the position.
• Experience conducting a Uniform Desk Review (UDR) and an audit for 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 Disproportionate Share Hospital (DSH), including sample selection and testing according to CMS standards.
• Experience reviewing IME/GME, including rotation schedules, bed counts, and testing according to CMS standards.
• Experience reviewing and appropriately approving an audit’s scope.
• Experience conducting supervisory reviews for certain provider types.
• Experience performing sample testing, transferring testing to the audit adjustment report, and explaining adjustments to providers so they understand them.
• Demonstrated leadership through involvement in junior auditor formal training, assistance on special projects, or service as a Subject Matter Expert (SME).
• Ability to prepare workpapers according to CMS standards.
• Good working knowledge of applicable software applications.
• Ability to serve effectively as a mentor to less-experienced staff.
• Demonstrated engagement, commitment to departmental success, professionalism, ownership, and ability to complete work within prescribed deadlines and reliably work the time necessary to complete duties.
• Ability to attend meetings on time, provide management and coworkers adequate notice when unexpected issues arise, and ensure work is covered during absences.
• Demonstrated oral and written communication skills.
• Demonstrated ability to exercise independent judgment and discretion.
• Demonstrated attention to detail.
• Must meet applicable pre-employment background investigation, drug-screen, identity-proofing, and government suitability requirements.
• 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; Employment Authorization Cards are not substitutes for visas or U.S. Permanent Resident Cards.
• The Federal Government and CMS may require applicants to have resided in the United States for at least three of the last five years; the years need not be consecutive.

Nice To Haves

• Two to three years of Medicare cost report auditing experience.
• Experience independently reviewing Nursing & Allied Health Education (NAHE), including calculating the additional add-on payment and performing relevant testing.
• Experience independently reviewing organ acquisition costs and performing relevant testing.
• MBA or CPA.

Responsibilities

• Analyze Medicare cost reports and calculate complex rate reviews for large and medium facilities to support accurate interim payments.
• Calculate cost-to-charge ratios (CCRs) and provider payment information from cost reports, ensuring accuracy.
• Compare current-year and prior-year cost reports and complete desk reviews; coordinate with the Lead on field audits and lead field audits for providers of varying sizes and Medicare cost report appeals.
• Conduct supervisory reviews of other audit staff’s desk reviews, providing review points and coaching, mentoring, and training less-tenured staff; ensure desk reviews, appeals, and field audits comply with CMS regulations and Government Auditing Standards.
• Maintain constructive provider relations, communicate professionally, assist providers with problem areas, and advise them on Medicare policy questions.
• Schedule audits and desk reviews to meet CMS requirements and internal production goals.
• Research, plan, and implement special projects concerning complex payment methodologies, including training staff and meeting CMS implementation timelines.
• Assign and develop auditors based on training needs, explain assignments and objectives, provide constructive feedback, and determine future training needs.
• Identify departmental training needs and train staff on reimbursement principles, rate-review processes, and first-level review of rates ranging from simple to complex.
• Serve as a departmental mentor and ensure work products meet or exceed CMS expectations.
• Attend entrance and exit conferences, advise providers on Medicare policy questions as needed, and complete required continuing education training.
• 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
• Career Level: Senior