PARD Auditor - Novitas Solutions

Overview

This role supports provider audit and reimbursement activities for Medicare. Responsibilities include desk review/audit and interim rate review work, analyzing cost reports and provider statistical and reimbursement report information to determine accurate and timely tentative settlements of bad debt payments or other pass-through costs. The position may also assist senior staff who perform hospital audits.

Responsibilities

• Analyze cost reports and provider statistical and reimbursement (PS&R) information to determine accurate and timely Skilled Nursing Facility (SNF), End Stage Renal Disease (ESRD), and Federally Qualified Health Centers (FQHC)/Rural Health Clinics (RHC) tentative settlements of bad debt payments or other pass-through costs.
• Review cost reports and accompanying bad debt logs to update pass-through payment amounts and determine lump-sum adjustments for interim rate accuracy. (30%)
• Perform limited and full desk reviews of cost reports for SNFs, ESRDs, FQHCs/RHCs, and hospitals that receive Medicare reimbursement.
• Generate and customize required internal and external correspondence and checklists to support implementation and evidence of desk review completion. (30%)
• Coordinate with the Senior and/or In-Charge auditor on hospital audits.
• Complete post-audit activities, including follow-up with provider representatives and preparing the final cost report package. (15%)
• Support special projects, which may include duplicate interns and residents (IRIS) data, transmission of cost report information (HCRIS), wage index submissions, system updates for tracking audit and reimbursement (STAR), tracking providers and cost reports and continuing education and training (CET), HFS cost report software, SNF pass-through logs, and PS&R backup. (10%)
• Assist management with administrative functions for the department, including creating and maintaining electronic and hard copy provider cost report files and participating in continuous improvement projects. (5%)
• Attend entrance and exit conferences and advise healthcare providers on Medicare policy questions as needed. (5%)
• Perform other duties as assigned by the supervisor. (5%)

Requirements

• 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.
• Demonstrated oral, written, and interpersonal communication skills.
• Computer skills, including knowledge of Microsoft Office suite (Excel, Word, Outlook, PowerPoint).

Federal Eligibility, Screening, and Identity Requirements

• Federal Government and Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years. These years of residence do not have to be consecutive.
• If selected, candidates must undergo a pre-employment Background Investigation, Drug Screen, and have identity proofing documentation cleared prior to hire.
• Most positions may require additional identity proofing, fingerprinting, and additional background investigation screening to be granted Enterprise User Administration (EUA) system logical access after employment begins.
• Continued employment is contingent upon the outcome of complete additional screening criteria required for the position, including suitability for access to CMS information and information systems.
• Employment may be subject to corrective action, up to and including immediate termination, if the candidate is found not suitable.
• Candidates must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Employment Authorization Cards (EAD) are not a substitute for visas or U.S. Permanent Resident Cards.

Preferred Qualifications

• N/A

Compensation & Benefits

• Medical, dental, vision, life, and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

Location

Remote work is available in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, 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.