Provider Audit and Reimbursement Manager (CMS)

ZipRecruiter; Jacksonville (FL); Remote; USD 70,000 - 100,000; Full time

Job summary

A top-ranked recruiting firm is seeking a Provider Audit and Reimbursement Manager for a remote position. The ideal candidate will manage a team, ensure compliance with Medicare laws, and have a strong background in audit and reimbursement. This role offers potential for significant career advancement in a respected organization.

Qualifications

• At least 4 years' experience in Medicare audit and reimbursement.
• 3 years in supervisory or leadership roles.
• Strong communication skills and attention to detail.

Responsibilities

• Manage team members and workload to ensure compliance with CMS standards.
• Oversee daily activities and coordinate with other departments.
• Review workpapers and audit reports for correctness and compliance.

Skills

Communication

Attention to detail

Education

Bachelor's or Master's degree in Accounting or Finance

MBA

Job description

Job Description: PROVIDER AUDIT AND REIMBURSEMENT MANAGER (CMS) - REMOTE

ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Manager (CMS)! Must have experience with Medicare Cost Reports. This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization offering tremendous career growth potential.

100% REMOTE!

Candidates must currently have PERMANENT US work authorization.

Job Description:

The Provider Audit and Reimbursement Manager is responsible for managing a team of auditors and ensuring the work is performed in compliance with the Medicare laws and regulations, the standards set forth by the Centers for Medicare and Medicaid Services (CMS), the company's and department's quality and production standards, and the company's policies and procedures. The Manager will be responsible for either audit or reimbursement functions and can be responsible for one of four primary roles -- desk review/audit, reopenings/appeals, interim rate review/reimbursement or acceptance/finalization for all provider types as both a preparer and reviewer of work product. The Manager assigns annual workload budget, distributes assignments to the team, ensures timely and accurate completion and review of all work, and makes final reimbursement determinations for all work assigned to the team.

Essential Duties & Responsibilities:

1. Manage team members and workload of the Audit/Reimbursement unit to ensure compliance with CMS standards, Medicare laws, regulations, and budget constraints.
2. Oversee daily activities of the Audit/Reimbursement unit, coordinate with other departments and external entities, and manage team locations.
3. Coordinate and manage reimbursement for services, update interim rates, and ensure data entry into claims processing systems.
4. Test and validate pricing software releases in the payment system.
5. Manage audits, provide guidance to team members, and coordinate duties.
6. Maintain and control audit and appeal assignments, schedule resources.
7. Ensure completion of objectives within quality, policy, regulation, and budget limits. Plan audit work for desk and field.
8. Review workpapers for correctness and compliance, ensure proper documentation and conclusions.
9. Review, evaluate, and approve disbursements of tentative cost settlements per federal regulations.
10. Make accounting decisions related to audits, consult with senior management as needed.
11. Review and approve completed audit reports.
12. Participate in entrance and exit conferences, assist auditors, follow up on recommendations, and respond to inquiries.
13. Research policies and regulations affecting cost settlements.
14. Attend meetings, assist providers, and respond to inquiries.

Required Qualifications:

• Bachelor's or Master's degree in Accounting or Finance, or relevant coursework if in other fields.
• At least 4 years' experience in Medicare audit and reimbursement, including 3 years in supervisory or leadership roles.
• Strong communication skills, ability to exercise judgment, and attention to detail.

Additional Qualifications:

• Masters in Business Administration (MBA)
• Certified Public Accountant (CPA)

This remote work opportunity is available in specific states listed, with some locations requiring further approval or offering in-office/hybrid options.

To apply, send your resume to John Burke at [e-mail] or apply online at www.arcgonline.com.

ARC Group is a top-ranked recruiting firm committed to equal employment opportunities and fostering an inclusive environment. Accommodations available upon request.