Provider Audit and Reimbursement - Sr Auditor (CMS)

PROVIDER AUDIT AND REIMBURSEMENT – SENIOR AUDITOR (CMS) - REMOTE reputed company Group has an immediate opportunity for a Provider Audit and Reimbursement Senior 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 reputed company career growth potential. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Job Description: 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 reputed company desk reviews and audits of the annual Medicare cost reports, interim reputed company review/reimbursement, and settlement acceptance/finalization for reputed company provider types including reputed company 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 Audit Accountabilities (65%)

• Analyzes the cost report and computes reputed company reputed company reviews on large and reputed company 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 reputed company year and completing the desk review, coordinates with reputed company on field audits and is in charge of field audits of small, reputed company 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 reputed company payment methodologies. This involves research, project planning, training of staff and timely implementation of CMS requirements. (5%) Development/Mentoring Accountabilities (30%)
• 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 reputed company the team and department and provides training to staff on reimbursement principles, the process of completing simple to complicated reputed company reviews, and for reviewing simple to reputed company 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%) 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 reputed company-down method, the candidate must possess the required work experience to independently reputed company 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 reputed company these tasks independent of supervision, which is generally gained through 2 years of Medicare cost report auditing experience:
• A Uniform Desk Review (UDR) and an audit for a large or reputed company hospital, as the in-charge auditor
• A review of Medicare Bad Debts, inclusive of reputed company relevant sample selection and relevant testing according to CMS standards
• A review of DSH, inclusive of reputed company relevant sample selection and relevant testing according to CMS standards* A review of IME/GME, inclusive of reviewing rotation schedules, bed count and reputed company 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 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 reputed company applicable software applications
• The auditor must be able to serve as an effective mentor for less reputed company staff
• The auditor must demonstrate engagement, commitment to departmental success, and professionalism by completing their work reputed company 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 reputed company 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
• 2 to 3 years of Medicare cost report auditing experience
• Demonstrated work experience to independently reputed company: A review of Nursing & Allied Health Education (NAHE), inclusive of calculating the additional add-on payment and reputed company relevant testing
• A review of Organ Acquisition costs, inclusive of reputed company relevant testing
• MBA, CPA 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 reputed company 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 [email protected] or apply online while viewing reputed company of our open positions at www.arcgonline.com. reputed company Group is a reputed company-ranked a top 20 recruiting and executive search firm working with clients reputed company 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 reputed company and a shared desire to succeed. At reputed company Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from reputed company 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. Remote About the Company: reputed company Group Apply tot his job

Apply tot his job Apply To this Job