PARD In-Charge Auditor

Overview

This role supports healthcare provider audits and Medicare reimbursement work using knowledge of Medicare laws, regulations, and Centers for Medicare and Medicaid Services (CMS) instructions and provider policies. The work includes desk reviews and audits of annual Medicare cost reports, evaluation and research of provider wage information for billing appropriateness, and developing correct annual Medicare reimbursement settlements while protecting the interests of providers, CMS, and taxpayers.

Responsibilities

• Perform provider interim rate reviews, tentative settlements, cost report appeals, and full and limited desk reviews requiring increased skill and increasing complexity, including the ability to audit small to medium-sized hospitals (20%)
• Coordinate with the Senior and/or Lead auditor on field audits; serve as in-charge auditor of field audits of small to medium-sized providers (20%)
• Analyze cost reports and establish appropriate inpatient and outpatient interim reimbursement rates and other payment factors by analyzing pertinent financial and statistical data and applying applicable regulations and reimbursement principles (20%)
• Complete most assigned audit/reimbursement functions with a minimum of supervision or assistance; recognize errors; make judgments about materiality and the need for additional time and audit steps; self-check for errors (20%)
• Establish audit timing and scheduling within the allotted time budget; prepare audits by analyzing prior review versus the as-submitted cost report and developing a comprehensive information request to the provider (20%)
• Defend audit adjustments to the provider after collaboration with a manager or Lead (10%)
• Attend entrance and exit conferences and advise healthcare providers on Medicare policy questions, as needed (5%)
• Perform other duties as assigned by the supervisor, including attending and completing required number of hours of Continuing Education Training (CET) (5%)

Required Qualifications

• Bachelor’s degree or a combination of education and experience in disciplines such as auditing, accounting, analytics, finance, or similar experience in lieu of a degree
• Basic understanding of the Medicare cost report and required work experience to perform the following with a high degree of independence, generally gained through 1 year of Medicare cost report auditing experience:
  • A Uniform Desk Review (UDR) for a moderately complex hospital
  • An audit of a small to medium-sized facility
  • A review of Medicare Bad Debts, including all relevant sample selection and relevant testing according to CMS standards
  • A review of DSH, including all relevant sample selection and testing according to CMS standards
  • Sample testing, transferring of testing to the audit adjustment report, and explaining adjustments to the provider
• Ability to prepare workpapers according to CMS standards
• Good working knowledge of all applicable software applications
• Demonstrated engagement, commitment to departmental success, and professionalism, including:
  • Completing work within prescribed deadlines
  • Taking ownership of work
  • Serving as an example for more junior auditors and staff by consistently and reliably working the time necessary to properly complete duties
  • Timely attendance at meetings
  • Providing adequate notice to management and co-workers when unexpected issues arise
  • Ensuring work is properly covered during the auditor’s absence
• Demonstrated oral and written communication skills
• Demonstrated ability to exercise independent judgment and discretion
• Demonstrated attention to detail

Preferred Qualifications

• 1 1/2 to 2 years of Medicare cost report auditing experience

Compensation & Benefits

Benefits include:

• 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.

Additional Screening / Eligibility Requirements

• The Federal Government and 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 to be employed. These years of residence do not have to be consecutive.
• If selected, the applicant must undergo a pre-employment Background Investigation and Drug Screen; identity proofing documentation must be cleared prior to hire.
• Most positions are subject to additional identity proofing, fingerprinting, and additional background investigation screening required for Enterprise User Administration (EUA) system logical access after the start of employment.
• Continued employment is contingent upon outcomes of the complete additional screening criteria required for the position, including suitability for access to CMS information and information systems, and any additional investigation that may be required throughout employment. If not suitable, employment may be subject to corrective action, up to and including immediate termination.
• Identity documentation requirement: 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.