PARD Sr Auditor - First Coast

GuideWell Source; Florida; Hybrid; USD 90,000 - 130,000; Full time

Benefits offered by this job

Medical, dental, vision, life and…

401(k) with company match

Free gym memberships

Employee Incentive Plan

Employee Assistance Program

Job summary

GuideWell Source seeks a Provider Audit and Reimbursement Senior Auditor to perform desk reviews and audits of Medicare cost reports, interim rate reviews, and settlements for diverse provider types, including complex hospitals. The role includes mentoring Auditors and In-Charge Auditors, ensuring CMS compliance, and leading audit initiatives.

The candidate will work within a team of healthcare experts, applying extensive Medicare knowledge and supervisory skills to improve provider outcomes and

Qualifications

• Bachelor's degree or equivalent experience in auditing, accounting, analytics, finance, or related field.
• Uniform Desk Review (UDR) and audit experience for large/complex hospital.
• CMS standards testing and Medicare cost report knowledge.

Responsibilities

• Perform cost report desk reviews and audits for various provider types, including complex hospitals.
• Lead and mentor auditors; ensure reviews comply with CMS and Government Auditing Standards.

Skills

Auditing

Accounting

Analytics

CMS regulations

Leadership

Education

Bachelor's degree in a related field

Tools

CMS software

MS Office

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 health care 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 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 Senior Auditor utilizes advanced knowledge of Medicare laws, regulations, instructions from the Centers for Medicare and Medicaid Services (CMS), and provider policies to perform desk reviews and audits of the annual Medicare cost reports, interim rate review/reimbursement, and settlement acceptance/finalization for all provider types including complex and organ transplant hospitals, as both a preparer and reviewer of work product based on established performance goals. The position will mentor and train Auditors and In-Charge Auditors.

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.

Audit Accountabilities (65%)

• Analyzes the cost report and computes complex rate reviews on large and medium size facilities for accurate intern payments. (10%)
• Analyzes the cost report and completes the calculation of cost-to-charge ratios (CCRs) and provider payment information, ensuring accuracy. (10%)
• Analyzes the cost report by comparing the prior year to the current year and completing the desk review, coordinates with Lead on field audits and is in charge of field audits of small, medium and large sized providers and Medicare cost report appeals. (10%)
• Performs supervisory reviews of desk reviews performed by other members of the audit staff by providing relevant review points that facilitate the coaching, mentoring, and training of less tenured staff. Ensures that provider desk reviews, cost report appeals and field audits are completed in accordance with CMS regulations and Government Auditing Standards. (10%)
• Establishes or maintains constructive provider relations by demonstrating a professional approach, expressing positive corporate image and assisting provider in problem areas. Advises healthcare providers on Medicare policy questions. (10%)
• Establishes the timeliness and scheduling of audits and desk reviews to ensure compliance with requirements for CMS metrics and internal production goals. (10%)
• Accountable for special projects relating to complex payment methodologies. This involves research, project planning, training of staff and timely implementation of CMS requirements. (5%)
• Assigns and develops auditors based on their training needs; explains work to be performed and principle or objective of procedure; provides accurate, constructive feedback; determines future training needs. Identifies training needs within the team and department and provides training to staff on reimbursement principles, the process of completing simple to complicated rate reviews, and for reviewing simple to complex rates at the first review level. (10%)
• Serves as a mentor in the department. (10%)
• Ensures development of quality product that meets or exceeds CMS expectations. (10%)

Other (5%)

• Attends entrance and exit conferences and advises healthcare providers on Medicare policy questions as needed. This includes attending and completing the required number of hours of Continuing Education Training (CET). (5%)
• Performs other duties as the supervisor may, from time to time, deem necessary.

REQUIRED QUALIFICATIONS

• Bachelors' degree or a combination of education and experience in disciplines such as auditing, accounting, analytics, finance or similar experience in lieu of a degree
  In addition to having a thorough understanding of the Medicare cost report, including the step-down method, the candidate must possess the required work experience to independently perform the duties of the position.
• A Uniform Desk Review (UDR) and an audit for a large or complex hospital, as the in-charge auditor
• A review of Medicare Bad Debts, inclusive of all relevant sample selection and relevant testing according to CMS standards
• A review of DSH, inclusive of all relevant sample selection and relevant testing according to CMS standards
• A review of IME/GME, inclusive of reviewing rotation schedules, bed count and all relevant testing according to CMS standards
• A review and appropriate approval of an audit's scope
• A supervisory review of certain provider types (may vary by team)
• Sample testing, transferring of testing to the audit adjustment report, and explaining the adjustments to a provider with the achievement of understanding by the provider
• The auditor must display leadership skills by being integrally involved in junior auditor formal training or assisting on special projects, or have been a Subject Matter Expert (SME)
• The auditor must be able to prepare workpapers according to CMS standards
• The auditor must have a good working knowledge of all applicable software applications
• The auditor must be able to serve as an effective mentor for less experienced staff

Demonstrated oral and written communications skills

Demonstrated ability to exercise independent judgement and discretion

Demonstrated attention to detail

PREFERRED QUALIFICATIONS

• 2 to 3 years of Medicare cost report auditing experience
• A review of Nursing & Allied Health Education (NAHE), inclusive of calculating the additional add-on payment and all relevant testing
• A review of Organ Acquisition costs, inclusive of all relevant testing
• review of Organ Acquisition costs, inclusive of all relevant testing
• MBA,CPA

Requirements

The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.

Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment.

Identity Documentation: You 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. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards.

We are an Equal Opportunity/Protected Veteran/Disabled Employer.

This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL and PA in-office and hybrid work may also be available.

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