PARD Lead Auditor- Novitas - Remote, FL

Novitas Solutions, Inc.; Orlando (FL); Hybrid; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Provider Audit and Reimbursement Lead to join their dynamic team. This role is crucial in enhancing the Medicare delivery system for millions of beneficiaries. You will utilize your advanced knowledge of Medicare laws and regulations to conduct thorough audits and reviews, while also mentoring and guiding a team of auditors. If you are passionate about transforming healthcare and possess strong leadership and analytical skills, this is the perfect opportunity to make a significant impact in a supportive environment that values your contributions.

Benefits

Medical, dental, and vision insurance

401(k) plan with company match

Free telehealth benefits

Free gym memberships

Paid Time Off

Employee Assistance Program

Rewards and Recognition Programs

Short- and long-term disability benefits

Qualifications

• 2.5 to 3 years of Medicare cost report auditing experience required.
• Demonstrated leadership skills and ability to prepare workpapers.

Responsibilities

• Oversee the unit's daily workload and mentor less experienced auditors.
• Perform audit functions and maintain constructive provider relations.

Skills

Medicare cost report auditing

Leadership skills

Analytical skills

GAAP knowledge

GAAS knowledge

GAS knowledge

CMS standards familiarity

Education

Bachelor's degree in auditing, accounting, analytics, finance, or related fields

Tools

Relevant auditing software

Job description

Location

United States of America-USAUS

Job Description

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 healthcare providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.

Benefits info:

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

Summary Statement

The Provider Audit and Reimbursement Lead utilizes advanced knowledge of Medicare laws, regulations, instructions from CMS, and provider policies to perform desk reviews and audits of the annual Medicare cost reports, including interim rate review/reimbursement, and settlement acceptance/finalization for all provider types. The role includes mentoring and training auditors and overseeing the daily workload of the team.

Essential Duties & Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

Lead Accountabilities (60%)

• Coordinate with management by overseeing the unit's daily workload. Use independent judgment to make decisions regarding procedures, errors, and corrections. Prioritize work and develop plans for less experienced auditors.
• Analyze working papers and cost reports for errors.
• Review workpapers for correctness and compliance with standards such as GAAP, GAAS, GAS, and CMS policies.
• Review, evaluate, and approve disbursements of tentative cost settlements in compliance with regulations.
• Develop technical competence and foster team growth.
• Coordinate assignments and development of auditors, providing coaching and training.
• Manage internal quality control programs and ensure adherence to policies and standards.
• Facilitate development of QMS policies and procedures.

Auditor Accountabilities (40%)

• Perform audit functions, including non-routine tasks, and present workpapers to providers.
• Coordinate large or diverse audits independently.
• Use professional communication techniques.
• Establish and maintain constructive provider relations.
• Conduct entrance and exit conferences as needed.
• Perform other duties as assigned by management.

Required Qualifications

Bachelor's degree or equivalent experience in auditing, accounting, analytics, finance, or related fields. Must have 2.5 to 3 years of Medicare cost report auditing experience, including experience as an in-charge auditor for large or complex hospitals, and familiarity with CMS standards and procedures. Demonstrated leadership skills, ability to prepare workpapers according to CMS standards, and proficiency with relevant software are required.

Preferred Qualifications

3 to 4 years of Medicare cost report auditing experience, with specific experience reviewing Nursing & Allied Health Education (NAHE) and Organ Acquisition costs.

Additional Requirements

The Federal Government and CMS may require applicants to have resided in the U.S. for at least three of the last five years. The position is open to remote work in specified states, with some locations requiring further approval. In-office or hybrid options may be available in FL and PA.