PARD Sr Auditor - First Coast

GuideWell Source • Remote, OH

7d • Remote

About The Position

The Provider Audit and Reimbursement Senior Auditor uses advanced knowledge of Medicare laws, CMS instructions and regulations, and provider policies to prepare and review desk reviews and audits of annual Medicare cost reports, interim rate reviews and reimbursement, and settlement acceptance and finalization for all provider types, including complex and organ transplant hospitals. The role performs work to established performance goals and mentors and trains Auditors and In-Charge Auditors.

The position analyzes cost reports, calculates complex rate reviews, cost-to-charge ratios, and provider payment information, and performs desk reviews, field audits, and Medicare cost report appeals. It reviews work completed by other audit staff, helps ensure that audits comply with CMS regulations and Government Auditing Standards, maintains constructive provider relationships, and advises providers on Medicare policy. The role also schedules audits to meet CMS and internal production goals and handles special projects involving complex payment methodologies.

The Senior Auditor assigns and develops auditors, provides coaching and training, mentors department staff, and helps ensure high-quality work that meets or exceeds CMS expectations. The role also attends entrance and exit conferences, completes required continuing education training, and performs other duties as assigned by a supervisor.

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. In Florida and Pennsylvania, in-office and hybrid work may also be available. Specific counties and cities may require further approval. Employment is contingent on required pre-employment and government background screening and identity proofing.

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, two years of Medicare cost report auditing experience demonstrating the ability to independently perform the job duties.
• Experience as the 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 count, and relevant testing according to CMS standards.
• Experience reviewing and appropriately approving an audit's scope.
• Experience conducting supervisory reviews for certain provider types, which may vary by team.
• Experience with sample testing, transferring testing to the audit adjustment report, and explaining adjustments to providers to achieve their understanding.
• Leadership experience through involvement in junior auditor formal training, assistance with 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 effectively mentor less experienced staff.
• Demonstrated engagement, commitment to departmental success, and professionalism, including meeting deadlines, taking ownership of work, reliably completing necessary work, attending meetings on time, giving management and coworkers notice when unexpected issues arise, 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 to meet Federal Government and CMS requirements.
• Must have access to current, unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency documents; Employment Authorization Cards are not a substitute for visas or U.S. Permanent Resident Cards.
• Must clear pre-employment background investigation, drug screening, and identity proofing; continued employment is contingent on meeting applicable government customer screening requirements.

Nice To Haves

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

Responsibilities

• Analyze cost reports and compute complex rate reviews for large and medium-sized facilities to ensure accurate interim payments.
• Calculate cost-to-charge ratios and provider payment information and ensure their accuracy.
• Compare current- and prior-year cost reports, conduct desk reviews, coordinate with a Lead on field audits, and lead field audits of providers of varying sizes and Medicare cost report appeals.
• Conduct supervisory reviews of desk reviews completed by other audit staff and provide review points that support coaching, mentoring, and training.
• Ensure provider desk reviews, cost report appeals, and field audits comply with CMS regulations and Government Auditing Standards.
• Maintain constructive provider relationships, represent the company professionally, help providers address problem areas, and advise them on Medicare policy questions.
• Schedule audits and desk reviews to meet CMS metrics and internal production goals.
• Lead special projects involving complex payment methodologies, including research, project planning, staff training, and timely implementation of CMS requirements.
• Assign and develop auditors based on training needs, explain work and procedures, provide constructive feedback, and identify future training needs.
• Train staff on reimbursement principles, completing rate reviews of varying complexity, and reviewing rates at the first-review level.
• Mentor department staff and ensure development of quality work that meets or exceeds CMS expectations.
• Attend entrance and exit conferences, advise providers on Medicare policy as needed, and complete required continuing education training.
• Perform other duties as assigned by a supervisor.

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