Senior Provider Auditor

Noridian Healthcare Solutions, LLC; Fargo (ND); Remote; USD 59,000 - 99,000; Full time

Job summary

An established industry player is seeking a Provider Auditor to conduct audits and ensure compliance with Medicare regulations. This role involves interacting with healthcare providers, mentoring staff, and preparing detailed audit reports. The ideal candidate will have a strong background in Medicare rules and excellent communication skills. This position offers the opportunity to work remotely while contributing to the quality control and compliance of healthcare services. Join a team that values professional development and offers a comprehensive benefits package, making it an exciting opportunity for career growth.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

401k with Company Match

Education Assistance Program

Paid Sick Leave

Paid Holidays

Increasing PTO Accrual Plan

Employee Assistance Program

Casual Dress

Qualifications

• 3 years' Medicare auditing experience required.
• Advanced knowledge in Medicare regulations essential.
• Bachelor's degree in relevant field or equivalent experience.

Responsibilities

• Conduct audits to ensure proper reimbursement for health care providers.
• Mentor staff and provide training on audit methodologies.
• Prepare and submit reports on audit results.

Skills

Medicare rules and regulations

Accounting principles

Communication skills

Coaching and mentoring

Problem-solving

Education

Bachelor's degree in Accounting

Bachelor's degree in Business

Bachelor's degree in Finance

Tools

Microsoft Office Suite

Job description

Noridian - Fargo
4510 13th Ave S, Suite 1
Fargo, ND 58103, USA

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

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

• Possesses and maintains a high level of working knowledge in 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 staff at all levels by training, coaching, and providing constructive and positive feedback.
• Assists with new and existing employee training on department techniques, desk review and audit methodologies, policies and procedures.
• Provides professional judgement, strategic insight, and guidance to Provider Auditor I and II’s using their knowledge, experience, and research to ensure quality control is adequate and minimize risk for the team and organization.
• Performs less complex supervisory level reviews and coaches staff with feedback to strengthen their knowledge and skills to perform job functions effectively and efficiently.
• Enhances and maintains strong, professional working relationships with providers.
• Requires extensive knowledge of documentation requirements from audit testing through preparation of audit workpapers.
• Provides training to internal staff and participates in external outreach and education to the provider community.
• 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
• 3 years' Medicare auditing experience
• Knowledge of accounting theory and practices
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint)
• Advanced knowledge of Medicare rules, regulations (e.g., Code of Federal Regulations, Provider Reimbursement Manual) to ensure the reimbursement principles are properly applied to the Medicare Cost Report so that Medicare reimbursement is accurate.

Preferred Qualifications

• Bachelor's degree in Accounting, Business or Finance
• Excellent written and verbal communication skills
• Excellent organizational skills
• Ability to coach, advise, and develop others
• Demonstrated understanding of industry and enterprise objectives
• Excellent presentation skills

Environment and Cognitive/Physical Demands

• 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, Severance Package, 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 IDs 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.

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: $59,937.84 - $98,582.59

Other Compensation: Incentive Plan

This job will be posted until filled.