Provider Audit and Reimbursement - Lead Auditor (CMS)

Job Description

Job Description

PROVIDER AUDIT AND REIMBURSEMENT LEAD AUDITOR (CMS) - REMOTE

ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Lead Auditor (CMS)! 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 Lead 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, as well as interim rate review/reimbursement, and/or 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 and oversee daily workload of unit team.

ESSENTIAL DUTIES & RESPONSIBILITIES
Lead Accountabilities (60%):

• Coordinates with management by overseeing the unit's daily workload. Routinely uses independent judgment and discretion to make decisions for self and less experienced auditors with regard to additional time and procedures; identifies and raises errors to the attention of supervisor and/or provider and identifies and communicates actions to correct same. Prioritizes auditor work and ensures that audit work is completed on time. Recognizes data needs for self and other auditors; develops plan of work for less experienced auditors (10%)
• Analyzes working papers and cost reports for errors. (10%)
• Reviews workpapers of auditors for correctness, control and adherence to Generally Accepted Accounting Practices (GAAP), Generally Accepted Accounting Standards (GAAS) and Government Auditing Standards (GAS) as required. Examines and reviews workpapers upon completion of the audit to ensure compliance with CMS Uniform Desk Review (UDR), policy, or technical direction and reflects proper reference, clear and concise conclusion of the major audit categories and assembly of working papers into logical sequence. (10%)
• Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal and State Government regulations for each class/type of provider within area of responsibility. (5%)
• Develops technical competence and constructive work attitudes in self and less experienced auditors; strives to build an effective team and to develop the growth needs of individual members of his/her team. (10%)
• Coordinates the assignments and subsequent development of auditors based on their training needs; explains work to be performed and principle or objective of procedure; provides accurate and constructive coaching, mentoring, and training of team members. Identifies training needs within the team and/or department. (5%)
• Manages, implements and coordinates an internal quality control program in conjunction with the Internal Quality Control (IQC) department and provides reasonable assurance that the Provider Audit and Reimbursement Department has established, as well as is following, adequate policies, procedures, and is following applicable auditing standards. (5%)
• Facilitates the development of Quality Management System (QMS) policies and procedures. (5%)

Auditor Accountabilities (40%)

• Performs audit functions including those which are non-routine; keeps track of instructions for many projects simultaneously. Presents and defends adjustments and workpapers to provider with minimal consultation from manager. (10%)
• Coordinates large audits and/ or diverse audits independently while seeking help on truly unusual or major items. (10%)
• Uses professional communication techniques in own and auditor's work and in conclusions drawn from the work. (5%)
• Establishes and maintains constructive provider relations by demonstrating a professional approach, expressing positive corporate image. Advises providers on Medicare policy questions and directs other questions to responsible departments or personnel. (5%)
• Conducts entrance and exit conferences and meetings away from office as needed. (5%)
• Perform other duties as the manager may deem necessary (5%)
  

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.
  

To demonstrate the necessary experience, the candidate must have performed the following tasks at a sufficiently successful level to show understanding of the work, judgment, and the ability to perform these tasks independent of supervision, which is generally gained through 2.5 to 3 years of Medicare cost report auditing experience:

• 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 testing according to CMS standards
• A review of DSH, inclusive of all relevant sample selection and 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 and approval of all work papers* 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* Assistance to audit management in the assignment and monitoring of workload, as well as leading junior team members

Additionally:

• 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
• The auditor must demonstrate engagement, commitment to departmental success, and professionalism by completing their work within prescribed deadlines, taking ownership of their work and setting an example for more junior auditors and staff by consistently and reliably working the time necessary to properly complete their duties, timely attending meetings, providing adequate notice to management and co-workers when unexpected issues arise, and ensuring work is properly covered in the auditor's absence.
• Demonstrated oral and written communications skills
• Demonstrated ability to exercise independent judgement and discretionDemonstrated attention to detail
  

PREFERRED QUALIFICATIONS
3 to 4 years of Medicare cost report auditing experience
Demonstrated work experience to independently perform:

• 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
  Requirements
  

This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, KY, 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.

Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke View email address on us.fitly.work or apply online while viewing all of our open positions at

ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.

At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.

Position is offered with no fee to candidate.