Provider Auditor II

Noridian Healthcare Solutions, LLC; Fargo (ND); Remote; USD 52,000 - 86,000; Full time

Job summary

Noridian Healthcare Solutions, LLC is seeking a Provider Auditor II to conduct audits for Medicare reimbursement. The role involves interacting with healthcare providers, ensuring compliance with regulations, and mentoring junior auditors. This position offers a remote work opportunity and requires a Bachelor's degree along with Medicare auditing experience.

Benefits

Health, Dental and Vision Insurance

401k and Company Match

Education Assistance Program

Paid Sick Leave

Increasing PTO Accrual Plan

Qualifications

• 1-year Medicare auditing experience required.
• Demonstrated knowledge of Medicare/Medicaid regulations.
• Ability to mentor junior staff.

Responsibilities

• Conduct audits to ensure proper reimbursement for Medicare programs.
• Mentor and train Auditor I and II staff.
• Prepare and submit audit reports.

Skills

Knowledge of Medicare rules

Proficient in Microsoft Office Suite

Excellent written and verbal communication skills

Organizational skills

Education

Bachelor's degree in Accounting, Business, Finance

Tools

Medicare Cost Report software

Job description

Join to apply for the Provider Auditor II role at Noridian Healthcare Solutions, LLC

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Join to apply for the Provider Auditor II role at Noridian Healthcare Solutions, LLC

*Position is eligible for Remote / Work from Home opportunity*

Department: Provider Audit

Telecommuting Eligible: Yes

Job Grade: E11

As a condition of employment physical work location must be in one of the 50 states or the District of Columbia.

Notice of Collection & Privacy Policy for Applicants Residing in California: California Applicant Privacy Policy | Noridian (noridiansolutions.com)

Job Title

Provider Auditor II

Job Summary

The Provider Auditor is responsible for conducting Centers for Medicare & Medicaid Services (CMS) and other financial analysis, limited and full desk reviews, and in-house and on-site field audits to ensure proper reimbursement for health care providers for the Medicare programs. These positions are the face of Noridian interacting with providers/facilities management through the audit process which requires an advanced level of professionalism. Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plans, and prepares/submits reports on the results of audits.

Essential Functions

Key Duties/Responsibilities/Accountabilities

• Requires an intermediate level of working knowledge of Medicare rules, regulations (e.g., Code of Federal Regulations, Provider Reimbursement manual) to ensure reimbursement principles are properly applied to the Medicare Cost Report so that Medicare reimbursement is accurate
• Mentors Auditor I and Auditor II level staff by training, coaching, and providing constructive and positive feedback
• Identifies areas of opportunity, provides solutions and works towards implementation and/or training, documenting the updates and procedures for efficiency and process improvement
• Provides support and input for specialized and in-depth projects with increased complexity
• Resolves cost report reopening requests as assigned, reviewing documentation submitted to determine accuracy of the request and proposing applicable adjustments to the cost report
• Works with externally facing provider representatives when necessary to resolve appeal cases, including writing position papers and auditing documents
• Possesses ability to Lead basic audits
• Requires advanced knowledge of documentation requirements from audit testing through preparation of audit workpapers
• Must obtain a minimum of 80 CET hours every two years.
  
  
  

Non-Essential Duties And Functions

• Other duties as assigned
  
  
  

Minimum Qualifications

• Bachelor's degree in Accounting, Business, Finance or equivalent work experience
• 1-year Medicare auditing experience
• Knowledge of accounting theory and practices
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint)
• Demonstrated knowledge of Medicare/Medicaid regulations, health care terminology, and various software packages and applications such as Medicare Cost Report software (HFS Software)
  
  
  

Preferred Qualifications

Above requirements and the following:

• Bachelor's degree in Accounting, Business or Finance
• Excellent written and verbal communication skills
• Excellent organizational skills
  
  
  

Environment and Cognitive/Physical Demands

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone use
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting to 15 pounds
• Infrequent stooping
  
  
  

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

Statement Of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Total Rewards Package:

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal, and agency specific regulations and related clauses included in Noridian prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

An employee in this position may be required to possess a “Federal Identification Card” (Federal ID) as a condition of employment. Federal ID’s may include one of the following: Personal Identity Verification (PIV) card, Personal Identity Verification-Interoperable (PIV-I) card, a Local-Based Physical Access Card issued by CMS, or a Local-Based Physical Access Card issued by another Federal agency and approved by CMS. Obtaining a Federal ID and continued eligibility for this position may require the successful completion of a Federal Background Investigation performed by the Federal Government and a residency requirement that you have lived in the United States at least three out of the last five years. Failure to obtain a Federal ID may result in the removal from the position or termination of employment.

Equal Employment Opportunity

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Below is the salary range for potential new hires.

Salary Range: The pay range for this position is $52,120.20 - $85,724.33 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Other Compensation: Incentive Plan & Lifestyle Benefit

This job will be posted until filled.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Accounting/Auditing and Finance

• Industries

  Hospitals and Health Care, Non-profit Organizations, and Government Administration

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