Reimbursement Audi

Aston Carter•Owings Mills, MD

7d•$40 - $50•Remote

About The Position

The Reimbursement Auditor performs Medicare and Medicaid reimbursement audits and reviews hospital and provider cost reports to help ensure healthcare organizations receive accurate, compliant reimbursement. The role reviews financial information and supporting documentation used to substantiate reported healthcare costs, analyzes reimbursement methodologies, and identifies discrepancies and compliance issues as part of a large-scale healthcare reimbursement and cost report review initiative. This is a fully remote contract position based out of Owings Mills, Maryland.

Requirements

Experience performing healthcare reimbursement audits, cost report audits, or healthcare financial reviews.
Prior experience with Medicare and/or Medicaid reimbursement.
Hands-on knowledge of hospital cost reports and provider reimbursement processes.
Ability to interpret detailed financial records and supporting documentation.
Strong analytical skills and proficiency in performing reconciliations.
Strong attention to detail and ability to identify inconsistencies in large volumes of financial data.
Advanced proficiency with Excel and financial analysis tools.
Ability to document audit procedures and findings clearly, accurately, and comprehensively.
Bachelor's degree in Accounting, Finance, Business, Economics, Healthcare Administration, or a related field, or an associate degree supplemented by relevant experience.

Nice To Haves

Experience with Medicare Cost Reports.
Experience with Medicaid Cost Reports and Medicaid reimbursement methodologies.
Familiarity with CMS-2552-10 and related cost reporting requirements.
Experience with DSH (Disproportionate Share Hospital) programs.
Experience with supplemental payment programs and calculations.
Background in provider reimbursement and payment methodologies.
Experience in Medicare and Medicaid audit activities.
Exposure to healthcare financial review and reimbursement compliance.
Understanding of revenue cycle processes and claims processing in healthcare settings.

Responsibilities

Perform detailed Medicare and Medicaid reimbursement audits and comprehensive healthcare financial reviews.
Review and analyze hospital and provider cost reports for accuracy, completeness, and compliance with applicable regulations and guidelines.
Audit financial documentation and supporting schedules used to substantiate reported healthcare costs and reimbursement amounts.
Review Medicare cost reports, Medicaid reimbursement calculations, DSH-related information, and supplemental payment calculations based on assigned engagements.
Identify discrepancies, unsupported costs, reimbursement issues, and potential compliance concerns within provider submissions.
Analyze provider financial information, expenses, cost allocations, utilization data, and other supporting documentation to validate reported figures.
Perform reconciliations and validate reported amounts against underlying financial records and source documents.
Conduct root-cause analysis of reimbursement discrepancies and document audit findings and conclusions.
Prepare supporting audit workpapers and document conclusions, recommendations, and rationale clearly and in an organized manner.
Communicate audit findings, questions, and requests for additional documentation to healthcare providers and internal project stakeholders.
Support reviews involving state Medicaid programs, Medicare reimbursement, hospitals, health systems, physician and provider organizations, and healthcare networks.
Apply knowledge of healthcare reimbursement regulations, methodologies, and cost reporting requirements throughout the audit process.
Assist with recommendations for improving reimbursement reporting, audit readiness, and compliance practices.